Biodiesel and biogas are two very important sources of renewable energy worldwide, and particularly in the EU countries. While biodiesel is almost exclusively used as transportation fuel, biogas is ...mostly used for production of electricity and heat. The application of more sophisticated purification techniques in production of pure biomethane from biogas allows its delivery to natural gas grid and its subsequent use as transportation fuel. While biogas is produced mostly from waste materials (landfills, manure, sludge from wastewater treatment, agricultural waste), biodiesel in the EU is mostly produced from rapeseed or other oil crops that are used as food, which raises the 'food or fuel' concerns. To mitigate this problem, considerable efforts have been made to use non-food feedstock for biodiesel production. These include all kinds of waste oils and fats, but recently more attention has been devoted to production of microbial oils by cultivation of microorganisms that are able to accumulate high amounts of lipids in their biomass. Promising candidates for microbial lipid production can be found among different strains of filamentous fungi, yeast, bacteria and microalgae. Feedstocks of interest are agricultural waste rich in carbohydrates as well as different lignocellulosic raw materials where some technical issues have to be resolved. In this work, recovery and purification of biodiesel and biogas are also considered.
Uncontrolled chronic inflammation results in cardiovascular disease and early death. In this review, we studied the impact of rheumatoid arthritis on the cardiovascular system, including the early ...and accelerated development of atherosclerosis and its clinical manifestations, focusing on the inflammatory mechanisms leading to arterial wall damage, rapid atherosclerotic plaque formation, and thrombosis. Furthermore, the effect of medications used to treat rheumatoid arthritis on the cardiovascular system was studied. The effect of chronic inflammation and medication on traditional cardiovascular risk factors is not the main subject of this review. We observed that uncontrolled chronic inflammation and some medications directly impact all the stages of atherosclerosis. In conclusion, reducing inflammation and maintaining long-term remission in rheumatoid arthritis may prevent early atherosclerosis. We believe that this review will encourage a better interdisciplinary approach to the management of these patients and further research in this field.
Abstract Background Patients with rheumatoid arthritis have significant cardiovascular mortality and morbidity. Objective To investigate the effects of chronic inflammation in rheumatoid arthritis on ...cardiovascular morbidity association with cardiovascular risk factors risk factors. Mortality report is secondary just to show trends without sufficient statistical power as it is accidental endpoint. Methods A total of 201 individuals without previous cardiovascular disease, 124 with rheumatoid arthritis (investigation group) and 77 with osteoarthritis (control group), were included in the study and followed up for an average of 8 years to assess the development of fatal or non-fatal cardiovascular diseases. The incidence and prevalence of cardiovascular risk factors were also investigated. Results The total incidence of one or more fatal or nonfatal cardiovascular events was 43.9% in the investigation group and 37.5% in the control group. Of these patients, 31.7% and 30.9% survived cardiovascular events in the investigation and control groups, respectively. The most common cardiovascular disease among participants who completed the study and those who died during the study was chronic heart failure. The results of the subgroup analysis showed that strict inflammation control plays a central role in lowering cardiovascular risk. Conclusion A multidisciplinary approach to these patients is of paramount importance, especially with the cooperation of immunologists and cardiologists for early detection, prevention, and management of cardiovascular risks and diseases.
Purpose of Review
Hereditary angioedema (HAE) is a disorder affecting bradykinin regulation presenting as recurrent cutaneous or mucosal swelling. Treatment options include plasma-derived or ...human-recombinant C1-inhibitor, icatibant, or ecallantide. Due to the lack of knowledge and experience on the topic, the treatment of choice in pregnancy is plasma-derived C1-inhibitor, and reporting any new experience is recommended. This review presents current guidelines for HAE treatment with a focus on pregnancy and reviews all experience with icatibant use during pregnancy.
Recent Findings
Our experience of treating a pregnant nC1-INH HAE patient with icatibant is presented, with no adverse effects or abnormalities, to add to the growing knowledge of icatibant use during pregnancy.
Summary
Considering the limited number of attacks that our patient usually experiences, which continued at more or less the same frequency during pregnancy, we feel icatibant to be a safe choice for on-demand HAE treatment during pregnancy for such cases.
Various connective tissue diseases tend to affect specific organs, lungs being the organ with the most serious repercussions and consequences. The diagnosis of interstitial lung disease makes the ...treatment more difficult and worsens long-term prognosis and overall survival. Positive results from the registration studies of nintedanib led to approval of the drug for the treatment of idiopathic pulmonary fibrosis and chronic fibrosing interstitial lung diseases in connective tissue diseases. After registration, real-world data on the use of nintedanib are being collected in everyday clinical practise. The objective of the study was to collect and analyse real world experience gathered after the registration of nintedanib for the treatment of CTD-ILD and to show if the positive results collected from a homogeneous and “representative” study population can be applied to everyday clinical practice. We are presenting a retrospective observational case-series study of patients treated with nintedanib from the three largest Croatian centers specialised in the treatment of connective tissue diseases with interstitial lung diseases. Stabilisation or improved of lung function tests was reported in 68% of patients when changes in predicted FVC were observed and in 72% of patients when changes in DLco were analysed. Almost all of the reported patients (98%) were treated with nintedanib as an add-on drug to immunosuppressants. The most common side-effects were gastrointestinal symptoms and abnormal liver function tests in less extent. Our real-world data confirm the tolerability, efficacy and similar side-effects of nintedanib as reported in pivotal trials.
Key Points
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Interstitial lung disease is a common manifestation of several connective tissue diseases and its progressive fibrosing phenotype contributes to high mortality rate and many unmet needs regarding the treatment remain.
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Registration studies of nintedanib obtained sufficient data and positive results to support approval of the drug.
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Real-world evidence from our CTD-ILD centres confirm the clinical trial data regarding efficacy, tolerability and safety of nintedanib.
Rheumatoid arthritis (RA) increases the risk of cardiovascular mortality and morbidity, including a 50–60% increased risk of cardiovascular disease (CVD). Arterial hypertension (HT) is considered the ...major contributing risk factor for CVD development in RA patients. In this investigation, we compared the incidence and prevalence of HT between RA and osteoarthritis (OA) and the influence of HT on CVD development in CVD-naive patients in both groups. This was a prospective clinical cohort investigation with an 8-year follow-up period. A total of 201 participants, 124 with RA (investigation group) and 77 with OA (control group), without diagnosed CVD or symptomatic heart failure were included. After selection according to inclusion and exclusion criteria, both groups underwent initial and final visits, and the investigation group underwent annual visits to assess disease activity. Case report forms were completed for each visit. The obtained data were analyzed by a statistician. No difference in the incidence or prevalence of HT was found between the investigation and control groups. No difference in the prevalence of HT was reported between the study groups and age-standardized data from the general population. The investigation group had a higher incidence of CVD than the control group. RA participants with long-term remission had a marginally lower HT prevalence. Although previous studies reported a higher HT prevalence in RA than in OA and the general population, our findings did not support this. The RA group had a higher incidence of CVD, but it is possible that optimal disease control with long-term remission could reduce HT incidence and prevalence while also having beneficial effects on other cardiovascular risk factors (CV) and, consequently, CVD occurrence.
The cyclophosphamide as a predisposing factor for Posterior Reversible Encephalopathy Syndrome (PRES) and therapeutic option for systemic lupus erythematosus (SLE) is still confusing. The first and ...only case of PRES, probably induced by cyclophosphamide, in Croatia followed by the findings of 36 SLE patients diagnosed with PRES after treatment with cyclophosphamide worldwide are described. An 18-year-old Caucasian female patient with a 1-year history of SLE was admitted to the hospital due to lupus nephritis and acute arthritis. After the second dose of cyclophosphamide was administered, according to the Euro-lupus protocol, the patient presented with a grand mal status epilepticus. The differential diagnosis of neurolupus, cerebrovascular insult, and infection were excluded. The MRI findings showed brain changes in corresponding to PRES. The treatment consisted of antihypertensives, antiepileptics, antiedema therapy, mechanical ventilation, and avoiding further cyclophosphamide use. A Naranjo Adverse Drug Reaction Probability Scale total score of five and a probable reaction related to drug therapy (cyclophosphamide, PRES) was confirmed. In this systematic review, along with cyclophosphamide use, the main predisposing factors involved in PRES occurrence in SLE patients were active SLE and renal involvement. Due to the high number of simultaneously involved predisposing factors (max. six) and their overlapping effect, it is still not possible to clearly establish the role of every factor on PRES onset. The use of cyclophosphamide, as a contributing factor for PRES onset, should be carefully assessed, based on clinicians’ experience and knowledge, in the setting of active SLE.
U oko 50% bolesnika sa sistemskim eritemskim lupusom razvije se lupusni nefritis. Znakovi zahvaćenosti bubrega kao što su proteinurija ³0,5 g/24 h, osobito uz glomerularnu hematuriju i/ili cilindre u ...sedimentu indikacija su za biopsiju. Cilj imunosupresivne terapije u lupusnom nefritisu jest remisija uz nastojanje da se izbjegnu oštećenja uzrokovana lijekovima. Inicijalni lijekovi u LN-u razreda III (±V) i IV (±V) jesu intravenski ciklofosfamid (ukupna doza 3 g tijekom 3 mjeseca) ili mikofenolat mofetil (ili mikofenolična kiselina) u ciljnoj dozi od 3 g/dan tijekom 6 mjeseci, uvijek u kombinaciji s glukokortikoidima, dok se u membranskom nefritisu preporučuje mikofenolat mofetil u kombinaciji s glukokortikoidima. U bolesnika u kojih se prati poboljšanje nakon inicijalnog liječenja preporučuje se ili nastaviti s mikofenolat mofetilom u nižoj dozi (2 g/dan) ili uvesti azatioprin (2 mg/kg/dan), oba u kombinaciji s niskim dozama glukokortikoida najmanje tijekom 3 godine. U rezistentnim ili relapsirajućim oblicima lupusnog nefritisa preporučuje se zamijenti ciklofosfamid mikofenolat mofetilom, ili obrnuto, ili primijeniti rituksimab.
Lactobacillus coryniformis subsp. torquens DSM20004(T) is a d-lactate producer, with a portion of the d-lactate higher than 99.9% of total lactic acid produced. Acetate was identified as the second ...end-product that appeared at the end of the exponential growth phase in MRS medium when glucose concentration dropped to 38.41mM (6.92g/L). The acetate production was prolonged to the stationary phase, while the concentration of d-lactate remained constant. Other end-products were not identified by HPLC method. The known metabolic pathways of glucose fermentation in lactic acid bacteria do not produce the particular combination of these two end-products, but besides lactate and acetate also formate, ethanol and CO2 are produced. For comparison, the production of lactate and acetate by a d-/l-lactate producer Lactobacillus amylovorus DSM 20531(T) was also investigated. This strain produced equimolar quantities of d- and l-lactate in the MRS medium. Acetate was produced only when initial concentration of glucose was 55.51mM (10g/L) and production started in the exponential phase when concentration of glucose dropped to 35.52mM (6.40g/L). Similar behavior was observed with the initial concentration of maltose of 29.21mM (10g/L). An unstructured mathematical model was established for the bioprocess simulation.
Objective
To evaluate the 12-month efficacy and safety profile of adalimumab and etanercept in patients with ankylosing spondylitis (AS) and total spinal ankylosis (TSA).
Type of study design
...Case-series follow-up study.
Design
Twenty-eight patients (26 men and 2 women) with active AS (BASDAI > 4) and TSA were treated as follows: 19 patients receiving adalimumab and 9 patients receiving etanercept. Twelve-month data related to the efficacy and safety of these two TNF-alpha inhibitors were evaluated. The primary endpoint was ASAS 20 (the ASsessment in AS International Working Group criteria for 20% improvement) at weeks 12 and 52. Other measures that were evaluated were function (BASFI), disease activity (BASDAI), patient’s and physician’s global disease assessment on visual analogue scale (VAS) and C-reactive protein.
Results
In both adalimumab and etanercept groups, there was a significant improvement in all observed variables (baseline compared to weeks 12 and 52). This improvement was sustained for the whole follow-up period. In the adalimumab group, at week 12, ASAS 20 was achieved in 18/19 patients and at week 52 in 17/19 patients. In the etanercept group, at week 12 ASAS 20 was achieved in all patients and at week 52 in 6/9 patients.
Conclusion
In patients with active AS and TSA, adalimumab and etanercept treatment showed significant improvement in function and disease activity. No serious side effects or adverse effects were observed in our cohort.
Key Points
• TNF-alpha inhibitors can be effective treatment options for patients with AS and having total spinal ankylosis.
• Patients with advanced AS should not be disregarded as good candidates for treatment with biologic disease-modifying antirheumatic drugs.
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