Oesophageal fistula represents a rare but dreadful complication of atrial fibrillation catheter ablation. Data on its incidence, management, and outcome are sparse.This international multicentre registry investigates the characteristics of oesophageal fistulae after treatment of atrial fibrillation by catheter ablation. A total of 553 729 catheter ablation procedures (radiofrequency: 62.9%, cryoballoon: 36.2%, other modalities: 0.9%) were performed, at 214 centres in 35 countries. In 78 centres 138 patients [0.025%, radiofrequency: 0.038%, cryoballoon: 0.0015% (P < 0.0001)] were diagnosed with an oesophageal fistula. Peri-procedural data were available for 118 patients (85.5%). Following catheter ablation, the median time to symptoms and the median time to diagnosis were 18 (7.75, 25; range: 0–60) days and 21 (15, 29.5; range: 2–63) days, respectively. The median time from symptom onset to oesophageal fistula diagnosis was 3 (1, 9; range: 0–42) days. The most common initial symptom was fever (59.3%). The diagnosis was established by chest computed tomography in 80.2% of patients. Oesophageal surgery was performed in 47.4% and direct endoscopic treatment in 19.8% and conservative treatment in 32.8% of patients. The overall mortality was 65.8%. Mortality following surgical (51.9%) or endoscopic treatment (56.5%) was significantly lower as compared to conservative management (89.5%) [odds ratio 7.463 (2.414, 23.072) P < 0.001].Oesophageal fistula after catheter ablation of atrial fibrillation is rare and occurs mostly with the use of radiofrequency energy rather than cryoenergy. Mortality without surgical or endoscopic intervention is exceedingly high.

In the current study we assessed a new crystallized compound, 5-(1-hydroxybutyl)-4-methoxy-3-methyl-2H-pyran-2-one (C-HMMP), from the endophytic fungus Colletotrichum acutatum residing in the medicinal plant Angelica sinensis for its in vitro antimicrobial, antibiofilm, antioxidant, antimalarial, and anti-proliferative properties. The promising compound was identified as C-HMMP through antimicrobial-guided fraction. The structure of C-HMMP was unambiguously confirmed by 2D NMR and HIRS spectroscopic analysis. Antimicrobial property testing of C-HMMP showed it to be effective against a variety of pathogenic bacteria and fungi with MICs ranging from 3.9 to 31.25 μg/ml. The compound displayed excellent antibiofilm activity against C. albicans, S. aureus, and K. pneumonia. Furthermore, the antimalarial and radical scavenging activities of C-HMMP were clearly dosede-pendent, with IC50 values of 0.15 and 131.2 μg/ml. The anti-proliferative activity of C-HMMP against the HepG-2, HeLa, and MCF-7 cell lines in vitro was investigated by MTT assay, revealing notable anti-proliferative activity with IC50 values of 114.1, 90, and 133.6 μg/ml, respectively. Moreover, C-HMMP successfully targets topoisomerase I and demonstrated beneficial anti-mutagenicity in the Ames test against the reactive carcinogenic mutagen, 2-aminofluorene (2-AF). Finally, the compound inhibited the activity of α-glucosidase and α-amylase with IC50 values of 144.7 and 118.6 μg/ml, respectively. To the best of our knowledge, the identified compound C-HMMP was obtained for the first time from C. acutatum of A. sinensis, and this study demonstrated that C-HMMP has relevant biological significance and could provide better therapeutic targets against disease.

Olive Mill Wastewater (OMWW) is produced in large quantities and contains high levels of nutrients that can be reused for irrigation, reducing the demand for freshwater resources. However, OMWW is phytotoxic and expensive to treat, making it important to develop more cost-effective treatment methods. This study aims to investigate an integrated detoxification treatment sequence consisting of acid precipitation, Fenton oxidation, and electrical coagulation to safely reuse OMWW for barley germination. Raw, treated and diluted OMWW (25% and 50% OMWW) were tested. The results showed that raw and diluted OMWW suppressed seed germination at all concentrations, while diluted treated OMWW enhanced seed germination and plant growth. In addition, treated OMWW (acid precipitation treatment) at 25% dilution reported 0% phytotoxicity significantly improved plant growth, where plant fresh weight (FW) reached 123.33 mg. Moreover, α-amylase, lipase, and protease enzyme activity confirmed the superior enhancement of barley growth parameters, where the highest enzyme activity value recoded 0.870 mg maltose/g FW. The integrated treatments reduced detoxification by 97.90% for total phenolic, 98.37% for total flavonoids, and 99.18% for total tannins. Reductions of around 95.78%, 60.00%, and 78.90% in total organic carbon, electric conductivity, and total solids, respectively, were achieved. A significant decrease in heavy metals was observed with removal ratios 98.64%, 94.80%, 96.88%, and 95.72% for Fe, Cu, Mn, and Zn, respectively. Seedling Vigor Index as an indicator of crop productivity was successfully predicted using neural network modeling. Therefore, the applied method can be used as a fertilizer to support plant growth and reduce fertilization costs.

Detection of erythromycin (ERY) residues in commercial milk samples is crucial for the safety assessment. Herein, a printed circuit board was patterned as a feasible miniaturized potentiometric sensor for ERY determination in dairy samples. The proposed chip design fits to a 3.5-mm female audio plug to facilitate the potential measurements of working electrode versus reference one in this all-solid-state system. The sensor utilizes molecular imprinted polymer (MIP) for the selective recognition of the studied drug in such challenging matrix. The electrode stability is achieved through the addition of poly (3,4-ethylenedioxythiophene) nano-dispersion on its surface. The proposed device detects down to 6.6 × 10−8 M ERY with a slope of 51 mV/decade in the 1 × 10−7–1 × 10−3 M range. The results display high accuracy (99.9% ± 2.6) with satisfactory relative standard deviation for repeatability (1.6%) and reproducibility (5.0%). The effect of common antibiotic classes, namely, amphenicols, beta-lactams, fluoroquinolones, sulfonamides, and tetracyclines, can be neglected as evidenced by their calculated binding capacities towards the proposed MIP. The calculated selectivity coefficients also show a good electrode performance in the presence of naturally present inorganic ions allowing its application to different milk samples.

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Synthetic dyes from textile, paper, leather, and plastic processing, etc. are the majority of the colored effluents and have a harmful impact on human health and environment. Dye biosorption through endophytic fungi will be a challenge. A new fungus isolated from blueberry pulp was identified morphologically and genetically as Penicillium janthinellum LM5. It was utilized for the biosorption of synthetic dyes by forming mycelium particles with efficient decolorization properties in the dye solution. The results of decolorization experiments exhibited that dye type, pH, temperature and time were the important factors and the best decolorization condition on Congo red was pH 6.0, 30 ℃ and 48 h. Moreover, LM5 can achieve 90% decolorization rate even under the high salt concentrations of 200 mg/mL. Based on spectral analysis, the decolorization of Congo red was mainly attributed to the biosorption of mycelium and its pellet structure. Additionally, the fungus adsorbed Congo red can be as an excellent electrode material with a long-cycle performance and stable capacitance property, being a good way for recycling. In summary, this research employed a novel dye treatment method with simultaneous culture and decolorization through an endophytic fungus LM5, being a promising biomaterial in the application of dye wastewater treatment.

AbstractIn a controlled environment experiment, we studied how physiological changes in leaves during the vegetative phase regulate final grain yield of wheat crops in salt-affected soils. We also hypothesized that amendments such as biochar (SB) and selenium-chitosan nanoparticles (Se-NPs) can protect wheat plants from salt injury. 20-day-old wheat plants were submitted to 4-week salt stress (3000 ppm NaCl). Soybean straw biochar was mixed with soil media at planting and Se-NPs (30 ppm) was sprayed 5 days after the first salt stress treatment. At the end of 4-week Se-NPs treatment, one set of plants was harvested for studying leaf level physiological changes. The salt-stressed plants accumulated significantly high leaf Na+ (~ 13-fold increase), which trigged oxidative and osmotic damage. This salt-induced cellular injury was evident from significantly high levels of lipid membrane peroxidation and inhibited photosynthesis. Our study suggested that leaf physiological impairment in wheat plants was translated into poor biomass production and grain yield loss at crop maturity. Compared with control, salt-stressed plants produced 43% lesser biomass during vegetative phase, and 62% lesser grain yield at maturity. Amendments such as SB and Se-NPs protected the plants from salt-induced cellular injury by restricting Na+ transport toward leaf tissues. Plants treated with NaCl + SB + Se-NPs accumulated 50% less Na+ concentrations in leaves compared with NaCl-treated plants. Our study also suggested that SB and Se-NPs can restore ionic homeostasis and carbon assimilation in salt-stressed wheat by upregulating key transporter genes in leaves.

Motile aeromonads, and Cyathocotylidaespp.co-infections were identified in farmed Nile tilapia(Oreochromis niloticus) which suffering from mortalities. Moribund fish showed signs of septicemia, skin irritations, and respiratory distress. A total of 150 O. niloticus specimens showing signs of disease were collected from the affected earthmen ponds and examined. Bacteriological examination of fish samples revealed infections with motile aeromonads species. Phenotypic characteristics and phylogenetic analysis of gyrB gene sequences of aeromonads isolates identified them as Aeromonas hydrophila (12.6%), A.sobria (12.6%), and A. caviae (30.4%). Aeromonads strains harbored some virulence genes: Aer (78.62%); Hyl (60.86%); laf-A (52.17%); and Act (47.82%). The antibiogram of aeromonads showed high resistance against tetracycline (73.9%), and gentamycin (65.2%), while a high sensitivity was noticed to ciprofloxacin (82.6%),and trimethoprim/sulfamethoxazole (60.86%). Parasitological examination of fish revealed the presence of Cyathocotylidae spp. encysted metacercaria (EMC). High levels of interleukin 6 (IL-6) and cluster of differentiation 4 (CD4) were noticed in fish with parasitic and bacterial co-infection compared to those with a single infection or non-infected. Experimentally infected fish with Aeromonas spp. showed septicemic signs similar to that noticed in naturally infected tilapia with variable cumulative mortality. The study is one of the earlier reports identifying as Cyathocotylidae spp., and motile aeromonads co-infections, and their link with the exaggerated tilapia mortality which will be of value for incorporating these pathogens in the necessary management strategies to protect fish health.

Common antiepileptic drugs have complex pharmacokinetic characteristics leading to fluctuation in their plasma levels at the same therapeutic doses. Therefore, antiepileptic drugs turn out to be among the most common medications for which therapeutic drug monitoring (TDM) is crucial. Indeed, TDM provides a realistic approach to adjust drug doses in epilepsy care based on plasma concentrations to optimize its clinical outcome. Perampanel (PER) is an antiepileptic drug used for the treatment of primary generalized tonic-clonic seizures in combination with other drugs, such as carbamazepine (CAR). Drug-drug pharmacokinetic interactions are very common in this combination, which makes TDM of PER essential. A selective, accurate, and precise bioanalytical method has been developed for the simultaneous determination of PER and CAR in human plasma for the purpose of TDM. Liquid-liquid extraction using ethyl acetate was applied for sample preparation, and diazepam (DZP) was the internal standard. The adopted method could successfully determine PER and CAR within their cmax levels as the linearity range was 0.2–10 µg/mL for PER and 5–100 µg/mL for CAR. The chromatographic separation was achieved on a C8 column using acetonitrile, aqueous 0.1% glacial acetic acid (75 : 25, v/v) as a mobile phase in isocratic elution at a flow rate of 0.8 mL/min and an UV detection at 225 nm. The adopted method was validated according to EMA guidelines, and the results were within the acceptance criteria.

Background:Severe pruritus caused by progressive familial intrahepatic cholestasis (PFIC) and Alagille syndrome (AGS) is refractory to medical treatment. Surgical interruption of the enterohepatic circulation is considered the mainstay of alleviating distressing symptoms and delaying cirrhosis.

Aim and Objectives:

This study aims to evaluate the short-term effect of partial external biliary diversion (PEBD) on pruritus, liver disease progression, patient's growth, and quality of life.

Material and Methods:

This prospective cohort study enrolled children with PFIC and AGS from July 2019 to July 2021, whose guardians consented to the PEBD procedure. A standard surgical approach was performed by a single surgeon. Outcomes were measured subjectively and objectively pre- and post-procedure using the pruritus 5-D itching score, Paediatric Quality of Life Inventory scale (PedsQL), growth parameters, bile acids level, and liver function tests. Patients’ follow-up period ranged from 6 to 12 months.

Results:

Seven patients had PEBD procedure; five with PFIC and two with AGS. A significant improvement was detected in the 5-D itching score (p-value < 0.001), PedsQL (p-value < 0.001), and bile acids level (p-value 0.013). The preexisting growth failure was ameliorated. The downward trend in the bilirubin level was not significant. No influential difference in the other liver function tests occurred. No intra-operative complications encountered. Only one case had a post-operative stoma prolapse which was managed surgically.

Conclusion:

PEBD procedure could be considered as an effective and safe treatment options for intractable pruritus in patients with PFIC or AGS, providing preserved synthetic liver functions.

BackgroundThis study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa.
Methods
Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($).
Results
High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs.
Conclusion
High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.

Abstract Antiepileptic drugs are among the most common medications that require therapeutic drug monitoring (TDM). Indeed, TDM provides a realistic approach to adjust drug doses for epilepsy based on plasma concentrations to optimize its clinical outcome. The most common technique for TDM is high-performance liquid chromatography, which has a very low green profile among analytical techniques. Perampanel (PER) is an inherently fluorescent compound that its fluorophore readily allows sensitive and quantitative measurements. This paper describes the development and validation of a sensitive, specific, and eco-friendly spectrofluorimetric method for the determination of PER. Experimental parameters affecting fluorescence intensity of the compound, including solvent dilution, temperature, and excitation wavelength, were studied and optimized. The developed spectrofluorimetric method was established in acetonitrile at ?ex =?295?nm and ?em =?431?nm over a concentration range of 5?60?ng/ml. The adopted method was applied for the determination of PER in human plasma; it was effective in the range of 15?50?ng/ml. The proposed method was found to be sensitive and specific for PER and can be applied successfully in TDM of PER and in quality control laboratories.

The current investigation was carried out to assess the potential of fungi isolated from polluted soil samples in Al Jubail, Saudi Arabia, to degrade crude oil. In a minimal salt medium with 1% crude oil as the carbon source, the growth potential of various fungal isolates was examined. Among twelve fungal isolates, YS-6 and YS-10, identified as Cunninghamella echinulata and Mucor circinelloides based on multiple sequence comparisons and phylogenetic analyses, were selected as having superior crude oil degrading abilities. To the best of our knowledge, the isolated species have never been detected in polluted soil samples in the eastern province of Saudi Arabia. YS-6 and YS-10 have shown their capacity to metabolize crude oil by removing 59.7 and 78.1% of crude oil, respectively. Interestingly, they succeeded in reducing the surface tension to 41.2 and 35.9 mN/m, respectively. Moreover, the emulsification activity and hydrophobicity were determined to be 36.7, 44.9, 35.9, and 53.4%, respectively. The recovery assays included zinc sulfate, ammonium sulfate, acid precipitation, and solvent extraction techniques. All these approaches showed that the amount of biosurfactants correlates to the tested hydrocarbons. Furthermore, the enzyme activity of these two isolates generated significantly more laccase (Lac) than manganese peroxidase (MnP) and lignin peroxidase (LiP), as compared to the control. In conclusion, our study highlights new perspectives on the fungal resources found in persistently polluted terrestrial ecosystems. This knowledge will be useful for bioremediation, safe disposal of petroleum-oil contamination, and other industrial uses.