Ancillary treatment of patients with lung disease due to non-tuberculous mycobacteria: a narrative review

Background and ObjectiveNon-tuberculous mycobacterial lung disease (NTM-LD) manifests with bronchiectasis, inflammatory bronchiolitis, nodules, and/or cavitation. Bronchiectasis is characterized by permanently dilated airways wherein mucus accumulates, creating a vicious cycle of chronic injurious inflammation and recurrent infections. While antibiotics are an important part of the treatment of NTM-LD, airway clearance techniques to mitigate this pathogenic mechanism of bronchiectasis as well as other ancillary measures are also important components of NTM-LD treatment. The objective of this contemporaneous Narrative Review is to emphasize the importance of such ancillary measures.MethodsWe searched PubMed for the key words of “airway clearance”, “pulmonary rehabilitation”, “nutrition”, “swallowing dysfunction”, “gastroesophageal reflux”, “vestibular dysfunction”, or “cochlear dysfunction” with that of “non-tuberculous mycobacterial lung disease”, “bronchiectasis”, or “respiratory disease”. The bibliographies of identified articles were further searched for relevant articles not previously identified. Each relevant article was reviewed by one or more of the authors and a narrative review was composed.Key Content and FindingsHerein, we discuss five ancillary treatment measures that are pertinent to patients with bronchiectasis and NTM-LD: (I) airway clearance; (II) physical and pulmonary rehabilitation; (III) nutrition; (IV) diagnosis and mitigation of swallowing dysfunction and of gastroesophageal reflux disease (GERD); and (V) minimization of vestibular and cochlear dysfunction associated with some anti-NTM drugs.ConclusionsWhile antibiotics is often the central focus of treatment of NTM-LD, given its propensity for recurrent and recalcitrant infection, other ancillary measures to break the vicious cycle of injurious inflammation and infection should also be emphasized to optimize treatment success.     

Alcohol Screening During US Primary Care Visits, 2014–2016

BackgroundUnhealthy alcohol use is a significant health issue for the US population. The US Preventive Services Task Force (USPSTF) recommends screening adults 18 years or older for unhealthy alcohol use during primary care visits.ObjectivesTo evaluate alcohol screening among ambulatory visits made by US adult primary care patients and identify characteristics predictive of alcohol screening.DesignA series of cross-sectional analysis of the National Ambulatory Medical Care Survey (NAMCS) data collected from 2014 to 2016 was used to examine US primary care providers’ use of alcohol screening questionnaires and delivery of counseling on alcohol use.ParticipantsA total of 19,213 visits made by patients aged 18 years or older to a US primary care physician trained in family medicine or internal medicine.Main MeasuresAdministration of a validated alcohol screening questionnaire and counseling/education on alcohol use. Variation in alcohol screening by patient demographic characteristics, reason for office visit, length of office visit, chronic medical conditions, evaluation by assigned primary care physician, new patient to practice, and region.Key ResultsAlcohol screening with a validated questionnaire occurred during 2.6% (95% Cl: 0.9%, 4.3%) of visits. Alcohol counseling, provided either by the physician or by referral, was documented in 0.8% (95% Cl: 0.3%, 1.3%) of visits. Screening was significantly more likely if patients were seen by their assigned primary care physician (adjOR 4.38 (95% Cl: 1.41, 13.61)), a new patient to the practice (adjOR 4.18 (95% Cl: 2.30, 7.79)), or had several chronic medical conditions (adjOR 3.40 (95% Cl: 1.48, 7.78)). Patients’ sex, race/ethnicity, age group, or length of appointment time was not associated with screening for unhealthy alcohol use.ConclusionsScreening for unhealthy alcohol use using a validated questionnaire is uncommonly performed during US primary care visits. Interventions or incentives may be needed to increase uptake of USPSTF alcohol screening recommendations.KEY WORDS: alcohol screening, unhealthy alcohol use, primary care     

Early Life Low-Calorie Sweetener Consumption Impacts Energy Balance during Adulthood

Children frequently consume beverages that are either sweetened with sugars (sugar-sweetened beverages; SSB) or low-calorie sweeteners (LCS). Here, we evaluated the effects of habitual early life consumption of either SSB or LCS on energy balance later during adulthood. Male and female rats were provided with chow, water, and a solution containing either SSB (sucrose), LCS (acesulfame potassium (ACE-K) or stevia), or control (no solution) during the juvenile and adolescent periods (postnatal days 26–70). SSB or LCS consumption was voluntary and restricted within the recommended federal daily limits. When subsequently maintained on a cafeteria-style junk food diet (CAF; various high-fat, high-sugar foods) during adulthood, ACE-K-exposed rats demonstrated reduced caloric consumption vs. the controls, which contributed to lower body weights in female, but not male, ACE-K rats. These discrepant intakes and body weight effects in male ACE-K rats are likely to be based on reduced gene expression of thermogenic indicators (UCP1, BMP8B) in brown adipose tissue. Female stevia-exposed rats did not differ from the controls in terms of caloric intake or body weight, yet they consumed more SSB during CAF exposure in adulthood. None of the SSB-exposed rats, neither male nor female, differed from the controls in terms of total adult caloric consumption or body weight measures. The collective results reveal that early life LCS consumption alters sugar preference, body weight, and gene expression for markers of thermogenesis during adulthood, with both sex- and sweetener-dependent effects.     

Africane-type sesquiterpenoids from the Argentine liverwort Porella swartziana and their antibacterial activity

Seven africanes (1, 2a,b, 3-6), two of them new (1, 2a), three secoafricanes (7-9), one of them new (7), and two norsecoafricanes (10, 11a), one of them new (10), all of them swartzianin-type, have been isolated from an Argentine collection of the endemic liverwort Porella swartziana. The structures of the new compounds were established by extensive 1D and 2D NMR spectroscopic data. Absolute configurations of compounds 2a, 2b, and 10 were derived on the basis of CD spectra. The compounds were tested for activity against a variety of microbes, but none were found to exhibit significant antibacterial activity.     

Regulation of matrix metalloproteinases 2 and 9 activities by peroxynitrites in term placentas from type 2 diabetic patients

Matrix metalloproteinases (MMPs) are proteolytic enzymes related to a proinflammatory environment in several diseases, including diabetes, which can be activated by reactive nitrogen species. This work aimed to determine MMP-2 and MMP-9 activities and nitration in term placentas from type 2 diabetic patients and verify the hypothesis that peroxynitrites are positive regulators of placental MMP-2 and MMP-9 activities. For this purpose, term placentas from healthy and type 2 diabetic patients were analyzed for MMP-2 and MMP-9 levels and activities, protein nitration, and nitration of MMP-2 and MMP-9. Villous explants were cultured in the presence of peroxynitrites for further evaluation of MMP-2 and MMP-9 activities. We found that MMP-2 and MMP-9 activities were increased in term placentas from diabetic patients. These changes were found even when MMP-2 protein concentrations were diminished and MMP-9 protein concentrations were not changed in the diabetic group. Increased protein nitration and specific nitration of MMP-2 and MMP-9 were found in term placentas from diabetic patients. Peroxynitrites were able to increase the activity of placental MMP-2 and MMP-9. Taken together, this study has shown for first time that peroxynitrites can nitrate and activate MMP-2 and MMP-9 in the placenta, a nitrative pathway possibly related to MMPs overactivity in the placentas from type 2 diabetic patients.     

Impact of blinking on ocular surface and tear film parameters

Purpose

To investigate the influence of blinking on tear film parameters, ocular surface characteristics, and dry eye symptomology.

Recovery of End-of-Life Tyres and Mineral Wool Waste: A Case Study with Gypsum Composite Materials Applying Circular Economy Criteria

The building sector is currently undergoing a process of change due to concerns about the sustainability of the construction industry. The application of circular economy criteria to develop new, more sustainable construction products has become one of the major challenges for the society of the future. This research advances towards the development of new lightened gypsum composites that incorporate waste from end-of-life tyres and recycled fibres from mineral wool thermal insulation in their composition. The results show how it is possible to reduce the consumption of the original raw materials by replacing them with recycled rubber granular particles, developing new construction products that are lighter, with better water resistance and greater thermal resistance. Additionally, it is shown that the incorporation of recycled fibres from rock wool and glass wool insulation is a good solution to improve the mechanical resistance of lightened gypsum composites, giving these construction and demolition wastes a second useful life by reincorporating them in the process of manufacturing new prefabricated housing products.     

血小板糖蛋白Ⅰbα因子突变(A156V)导致其与血管性血友病因子相互作用缺陷

目的　研究在流体切应力作用下表达突变的细胞与固着的血管性血友病因子 (vWF)相互作用中GPⅠbα突变 (A15 6V)的意义。方法　在GPⅠbαcDNA中直接诱发的突变克隆到哺乳类表达载体pDX的EcoRⅠ位点 ,随后将突变的cDNA转染在CHOβⅨ细胞。人的vWF通过甘氨酸和氯化钠沉淀及在Sepharose 4B柱分离的方法从血液冷沉淀制剂中纯化。纯化的vWF固着在盖玻片上 ,在平行板液流室中进行细胞滚动研究 ,用相差电视显微镜观察。结果　表达GPⅠb Ⅸ Ⅴ复合物的CHO细胞能粘附于并滚动在固着的vWF表面 ,当用表达A15 6V突变的细胞进行试验时 ,这些细胞虽然能粘附于并滚动在固着的vWF表面 ,但是它们滚动的速度明显快于其野生型 ,这表明突变的GPⅠbα与vWF之间的受体配体键的解离速度受损 ,单克隆抗体AN5 1与突变的GPⅠbα结合明显减少 ,表明A15 6V突变产生了GPⅠbα氨基端配体结合区的构象改变。结论　突变致使A15 6V突变细胞与固着的vWF产生较快的解离速度。突变的多肽在GPⅠbα氨基端配体结合区发生构象改变。平行板液流室在评价GPⅠbα与vWF之间相互作用中是一种有用的工具