Aranidipine

The capacity and mechanism of heterotrophic nitrification-aerobic denitrification (HNAD) strain (H1) to remove carbon, nitrogen, disinfectants chloroxylenol (PCMX) and benzethonium chloride (BEC) were investigated in this study. PCMX was removed via metabolism and chemical oxygen demand co-metabolism process. BEC was eliminated through bacterial adsorption, which greatly inhibited the removal of other pollutants. Carbon source optimization tests revealed that glucose was the optimal carbon source for co-removal of pollutants under mixed disinfectants circumstances (PCMX + BEC). Comparing the groups without (G1) and with disinfectants (G2), the content of extracellular polymeric substances was higher, and hydrophobicity was enhanced under the hazardous conditions of G2. All the nitrogen metabolism functional genes in G2 were up-regulated, and the electron transport system activity was also improved. At the same time, G2 had lower reactive oxygen species content, which reduced the probability of resistance genes dissemination, but the abundance of most quantified resistance genes was elevated in G2. Toxicity assessment assays found a dramatic reduction in the virulence of G2's effluent compared with the mixed disinfectants. The results confirmed that H1 strain could be used to treat the disinfectant-containing wastewater, which may aid in the application of HNAD process.

The varied treatment response to inhaled corticosteroids (ICS) in patients with COPD and the associated increased risk of pneumonia necessitate a personalized ICS therapeutic approach. This is informed by blood eosinophil count (BEC), which predicts ICS treatment response. However, BEC appears to change in response to ICS treatment.

Does (1) BEC measured on ICS treatment (2) BEC measured off ICS treatment, or (3) the change in BEC during ICS treatment best predict treatment response to ICS in COPD?

The Fluticasone Salmeterol on COPD Exacerbations Trial (FLAME), a 52-week, double-blind randomized controlled trial compared long-acting beta-2 agonists (LABAs)/long-acting muscarinic antagonists (LAMAs) with LABA/ICS. Corticosteroids were prohibited during a 4-week run-in period. We chose patients previously on ICS, thereby allowing BEC before and after the run-in period to represent BEC on and off ICS, respectively. In this post hoc analysis, we revisited outcome data, exploring how the three BEC biomarkers interacted with treatment response to the ICS-containing regimen.

Our study showed that LABA/LAMA combination was superior, or at least noninferior, to LABA/ICS in curbing exacerbations for most FLAME participants. However, higher BEC off ICS, higher BEC on ICS, and significant BEC suppression during ICS treatment corresponded to superior response to LABA/ICS in terms of exacerbation rate, time to first exacerbation, and time to first pneumonia. In a subgroup, including 9% of participants, BEC changed significantly during ICS treatment (≥ 200 cells/μL), and higher BEC on ICS did not predict ICS treatment response. For these patients, BEC off ICS and BEC change proved more predictive. Excess pneumonia risk associated with ICS appeared to be confined to patients who do not benefit from this treatment. BEC was not predictive of treatment effects on lung function and health status.

This exploratory analysis advocates preferentially using BEC off ICS or BEC change during ICS treatment for guiding ICS treatment decisions. BEC measured on ICS is less predictive of treatment response.

ClinicalTrials.gov; No.: NCT01782326; URL: www.

gov.