Uric acid and acute kidney injury in high-risk patients for developing acute kidney injury undergoing cardiac surgery: A prospective multicenter study

PURPOSE

It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI.

DESIGN

Multicenter prospective international cohort study.

SETTING

Fourteen university hospitals in Spain and the United Kingdom.

PARTICIPANTS

We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥ 4 points, from July to December 2017.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7 mg/dL) and AKI. Elevated preoperative AUS (≥7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; P = .17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93-1.19, P = .37).

CONCLUSIONS

Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.

[Translated article] Validation of the Spanish version of the modified Harris score

BACKGROUND AND OBJECTIVES

Modified Harris Hip Score (HHS) is one of the most used scales in the assessment of patients with hip pathology. Although a Spanish cross-cultural adaptation has been recently published, there are many studies supporting its validity yet. Therefore, the aim of this study is to validate the newly adapted Spanish version of the HHS (ES-EHM), comparing it with the WOMAC scale.

MATERIALS AND METHODS

The ES-EHM scale was applied to 100 patients who underwent a total hip replacement, in three different situations: (1) prior to surgery (pre-surgical ES-EHM), (2) after surgery, with at least 2 years of follow up (after surgery ES-EHM), and (3) 6 months after the postsurgical registration (final ES-EHM). WOMAC questionnaire was also applied once. We analysed data of scale main score, pain score, function-related score as well as the mean of pre-surgical, postsurgical and final postsurgical ES-EHM scale, in both the ES-EHM and the WOMAC scales. Parameters of reliability, validity and sensitivity to change were obtained.

RESULTS

Clinically relevant improvement was observed (46.55 points) when comparing pre-surgical and post-surgical ES-EHM scores. However, no differences between postsurgical and final ES-EHM were detected. Even so, strong correlation was obtained between the following: (1) postsurgical ES-EHM and final ES-EHM scores, (2) ES-EHM and WOMAC scores, and (3) pain and function-related parameters of ES-EHM and WOMAC scores. Standardised response mean (SRM) was 2.99, test-retest reliability expressed by the intraclass correlation coefficient was 0.90 and Cronbach index 0.95.

CONCLUSIONS

The Spanish cross-cultural adaptation of the EHM scale shows to be reliable, valid and sensitive to change. Thus, the Spanish medical staff will be able to apply the ES-EHM scale with good scientific support.

Validation of the Spanish version of the modified Harris score

BACKGROUND AND OBJECTIVES

Modified Harris Hip Score (HHS) is one of the most used scales in the assessment of patients with hip pathology. Although a Spanish cross-cultural adaptation has been recently published, there are many studies supporting its validity yet. Therefore, the aim of this study is to validate the newly adapted Spanish version of the HHS (ES-EHM), comparing it with the WOMAC scale.

MATERIALS AND METHODS

The ES-EHM scale was applied to 100 patients who underwent a total hip replacement, in three different situations: (1) prior to surgery (pre-surgical ES-EHM), (2) after surgery, with at least 2 years of follow up (after surgery ES-EHM), and (3) 6 months after the postsurgical registration (final ES-EHM). WOMAC questionnaire was also applied once. We analyzed data of scale main score, pain score, function-related score as well as the mean of pre-surgical, postsurgical and final postsurgical ES-EHM scale, in both the ES-EHM and the WOMAC scales. Parameters of reliability, validity and sensitivity to change were obtained.

RESULTS

Clinically relevant improvement was observed (46.55 points) when comparing pre-surgical and post-surgical ES-EHM scores. However, no differences between postsurgical and final ES-EHM were detected. Even so, strong correlation was obtained between the following: (1) postsurgical ES-EHM and final ES-EHM scores, (2) ES-EHM and WOMAC scores, and (3) pain and function-related parameters of ES-EHM and WOMAC scores. Standardized response mean (SRM) was 2.99, test-retest reliability expressed by the intraclass correlation coefficient was 0.90 and Cronbach index 0.95.

CONCLUSIONS

The Spanish cross-cultural adaptation of the EHM scale shows to be reliable, valid and sensitive to change. Thus, the Spanish medical staff will be able to apply the ES-EHM scale with good scientific support.

Gas Permeability through Polyimides: Unraveling the Influence of Free Volume, Intersegmental Distance and Glass Transition Temperature

The relationships between gas permeability and free volume fraction, intersegmental distance, and glass transition temperature, are investigated. They are analyzed for He, CO2, O2, CH4, and N2 gases and for five similar polyimides with a wide range of permeabilities, from very low to extremely high ones. It has been established here that there is an exponential relationship between permeability and the free volume fraction, and between permeability and the most probable intersegmental distance as measured by WAXS; in both cases, with an exponential coefficient that depends on the kinetic gas diameter as a quadratic polynomial and with a preexponential positive constant. Moreover, it has been proven that the intersegmental distance increases linearly with the free volume fraction. Finally, it has been established that the free volume fraction increases with the glass transition temperature for the polymers tested, and that they depend on each other in an approximate linear way.

Identifying imprints of externally derived dust and halogens in the sedimentary record of an Iberian alpine lake for the past ∼13,500 years - Lake Peixão, Serra da Estrela (Central Portugal)

Iberian lacustrine sediments are a valuable archive to document environmental changes since the last glacial termination, seen as key for anticipating future climate/environmental changes and their far-reaching implications for generations to come. Herein, multi-proxy-based indicators of a mountain lake record from Serra da Estrela were used to reconstruct atmospheric (in)fluxes and associated climatic/environmental changes over the last ∼13.5 ka. Depositions of long-range transported dust (likely from the Sahara) and halogens (primarily derived from seawater) were higher for the pre-Holocene, particularly in the late Bølling-Allerød-Younger Dryas period, compared to the Holocene. This synchronous increase could be related to a recognized dust-laden atmosphere, along with the combined effect of (i) an earlier proposed effective transport of Sahara dust for higher latitudes during cold periods and (ii) the progressive Polar Front expansion southwards, with the amplification of halogen activation reactions in lower latitudes due to greater closeness to snow/sea ice (halide-laden) surfaces. Additionally, the orographic blocking of Serra da Estrela may have played a critical role in increasing precipitation of Atlantic origin at higher altitudes, with the presence of snow prompting physical and chemical processes involving halogen species. In the Late Holocene, the dust proxy records highlighted two periods of enhanced input to Lake Peixão, the first (∼3.5-2.7 ka BP) after the end of the last African Humid Period and the second, from the 19th century onwards, agreeing with the advent of commercial agriculture, and human contribution to land degradation and dust emission in the Sahara/Sahel region. The oceanic imprints throughout the Holocene matched well with North Atlantic rapid climatic changes that, in turn, coincided with ice-rafted debris or Bond events and other records of increased storminess for the European coasts. Positive parallel peaks in halogens were found in recent times, probably connected to fire extinction by halogenated alkanes and roadway de-icing.

Total hip arthroplasty associated with transverse subtrochanteric shortening osteotomy and conical stem fixation in Crowe type IV hip dysplasia

PURPOSE

Total hip arthroplasty (THA) in high-dislocated hip dysplasia is a surgical challenge, presenting difficulties in the biomechanical reconstruction of the hip. The purpose of the present study is to analyze clinical and radiological outcomes of a series of patients with Crowe type IV hip dysplasia who underwent a THA with transverse subtrochanteric shortening osteotomy and conical stem fixation in our Hip surgery unit.

METHODS

This non-interventional retrospective study included all patients diagnosed with Crowe type IV hip dysplasia who underwent a THA using a subtrochanteric shortening osteotomy and uncemented conical stem fixation between January 1, 2008, and December 31, 2015. Demographic, clinical and radiologic data were analyzed, including Harris Hip Score and Oxford Hip Score.

RESULTS

Seventeen hips in 13 patients were included in the final analysis. All patients were women and mean age was 39 years (range 35-45). Mean follow-up was 5.6 years (range 1-8). Average length of the osteotomy was 3.4 cm (range 3-4.5) and mean lowering of the center of rotation was 5.67 cm (range 3.8-9.1). Mean time for bone union was 5.5 months. No nerve palsy or non-union was detected at the end of follow-up period.

CONCLUSION

The use of cementless conical stem fixation associated with a transverse subtrochanteric shortening osteotomy for treating Crowe type IV hip dysplasia permits to correct the rotational alterations of the femur and provides good stability of the osteotomy, with very low risk of nerve palsy and non-union rates.

Saline Retention and Permeability of Nanofiltration Membranes Versus Resistance and Capacitance as Obtained from Impedance Spectroscopy under a Concentration Gradient

Impedance spectroscopy has been widely used for the study of the electrical properties of membranes for their characterization. The most common use of this technique is the measure of the conductivity of different electrolyte solutions to study the behavior and movement of electrically charged particles inside the pores of membranes. The objective of this investigation was to observe if there is a relation present between the retention that a nanofiltration membrane possesses to certain electrolytic solutions (NaCl, KCl, MgCl₂, CaCl₂, and Na₂SO₄) and the parameters that are obtained through IS measurements of the active layer of the membrane. To achieve our objective, different characterization techniques were performed to obtain the permeability, retention, and zeta potential values of a Desal-HL nanofiltration membrane. Impedance spectroscopy measurements were performed when a gradient concentration was present between both sides of the membrane to study the variation that the electrical parameters had with the time evolution.

Vision-Related Quality of Life after Cataract Surgery in West Africa

PURPOSE

To study vision related quality of life (VRQoL) before and after a massive cataract campaign in West Africa and the relationship with visual indicators.

METHODS

All the patients who received cataract surgery in Burkina Faso during a blindness prevention campaign were examined. VRQoL was assessed using a modified version of the WHO/PBD VF20. The questionnaire was changed to reflect the socioeconomic and local culture. Patients were interviewed by local interviewers before and three months after surgery. A quality of life related to vision index (QoL-RVI) was calculated.

RESULTS

A total of 305 patients underwent cataract extraction in at least one eye, of these, a total of 196 (64%) completed the study. Mean age was 61.97 ± 14.39 years. The majority of eyes had poor visual acuity (VA<20/200, log MAR: 1.0) preoperatively (88.70%) with a mean VA of logMAR 2.17 ± 0.70 (20/2000) which improved to 0.86 ± 0.64 LogMAR (20/150) 3 months after cataract surgery. QoL-RVI improved postoperatively in 90.2% of patients, did not change in 3.1% and was worse in 6.7%. Statistically significant differences were detected (Wilcoxon test p <0.05) for all items tested before and after surgeries. Correlations for the patients after operations showed that there was a statistically significant relation between a global estimated QoL-RVI and the VA previous to the surgery (-0.196 p=0.014), regarding the same index and the VA after the procedures (-0,35 p=0,00018).

CONCLUSION

Cataract surgery increases the quality of life of patients living in a developing country such as Burkina Faso and the improvement correlates with the recovery of the visual acuity.

Stress Response to Climate Change and Postharvest Handling in Two Differently Pigmented Lettuce Genotypes: Impact on Alternaria alternata Invasion and Mycotoxin Production

Many species of Alternaria are important pathogens that cause plant diseases and postharvest rots. They lead to significant economic losses in agriculture and affect human and animal health due to their capacity to produce mycotoxins. Therefore, it is necessary to study the factors that can result in an increase in A. alternata. In this study, we discuss the mechanism by which phenol content protects from A. alternata, since the red oak leaf cultivar (containing higher phenols) showed lower invasion than the green one, Batavia, and no mycotoxin production. A climate change scenario enhanced fungal growth in the most susceptible cultivar, green lettuce, likely because elevated temperature and CO₂ levels decrease plant N content, modifying the C/N ratio. Finally, while the abundance of the fungi was maintained at similar levels after keeping the lettuces for four days at 4 °C, this postharvest handling triggered TeA and TEN mycotoxin synthesis, but only in the green cultivar. Therefore, the results demonstrated that invasion and mycotoxin production are cultivar- and temperature-dependent. Further research should be directed to search for resistant cultivars and effective postharvest strategies to reduce the toxicological risk and economic losses related to this fungus, which are expected to increase in a climate change scenario.

Validation of the OPTIMIPARK Questionnaire: A Tool to Optimize Treatment in Parkinson's Disease

Background

Dopamine replacement therapy reduces most motor and nonmotor features of Parkinson's disease. However, with disease progression, adjustments of dopaminergics and the application of advanced therapies must be considered.

Objectives

To validate the OPTIMIPARK questionnaire as a tool to help clinicians make therapeutic decisions on patients treated with levodopa.

Methods

We tested a questionnaire including 9 items encompassing motor and nonmotor signs, complications, and disability in a multicenter, observational, cross-sectional study. A neurologist (neurologist 1 [N1]) assessed patients according to regular clinical practice and blinded to the OPTIMIPARK questionnaire score. Therapeutic decisions were classified as "no changes," "adjustment of conventional treatment," and "advanced therapy indicated." External neurologists (neurologist 3 [N3] and neurologist 4 [N4]), who only knew the patient age, years of disease, and current treatment, made their therapeutic decisions based on the OPTIMIPARK score. Concordance between the criterion of the N1 versus the OPTIMIPARK-based N3-N4 consensus was analyzed applying weighted κ. The area under Receiving Operating Characteristic (ROC) curves was calculated for OPTIMIPARK scores.

Results

A total of 113 patients with Parkinson's disease were included. The OPTIMIPARK-based decision led to a higher proportion of patients requiring therapeutic modification than N1 assessment (74% vs. 60%; P = 0.002). Concordance between the N1 and N3-N4 decisions was moderate, whereas interobserver agreement among N3 and N4 was high. Area Under the Curve(AUC) values of 0.83 and 0.82 were found for "no changes" and "advanced therapy indicated" decisions by the N1 neurologist.

Conclusions

OPTIMIPARK might be more sensitive than regular clinical practice in suggesting the need for a therapeutic change. Furthermore, the low and high scores identify with high accuracy well-adjusted patients and candidates for advanced therapy, respectively.

Enhancement of swine manure anaerobic digestion using membrane-based NH3 extraction

The influence of suspended solids and pH in anaerobically digested piggery wastewater on membrane-based NH₃ extraction was evaluated in batch tests. The increase in pH in the anaerobic broth from 8 to 9 resulted in an increase in NH₃ removal efficiencies from 15.8 % ± 0.1 % to 20.9 % ± 0.4 % regardless of the suspended solids. The influence of membrane based NH₃ extraction on piggery wastewater treatment was also assessed in a CSTR interconnected with PTFE membrane modules. The decrease in TKN concentrations mediated by membrane operation induced an increase in CH₄ yield from 380.4 ± 84.9 up to 566.1 ± 7.8 NmLCH₄ g VS fed^-1. Likewise, COD and VS removal efficiencies significantly increased from 33.0 % ± 2.0 % and 25.7 % ± 2.3 % up to 61.8 % ± 1.3 % and 37.9 % ± 1.8 %, respectively. Interestingly, the decrease in NH₃ concentration entailed a complete assimilation of VFA.

A simple algorithm for differential diagnosis in hemodynamic shock based on left ventricle outflow tract velocity–time integral measurement: a case series

Echocardiography has gained wide acceptance among intensive care physicians during the last 15 years. The lack of accredited formation, the long learning curve required and the excessive structural orientation of the present algorithms to evaluate hemodynamically unstable patients hampers its daily use in the intensive care unit. The aim of this article is to show 4 cases where the use of our simple algorithm based on VTI, was crucial. Subsequently, to explain the benefit of using the proposed algorithm with a more functional perspective, as a means for clinical decision-making. A simple algorithm based on left ventricle outflow tract velocity–time integral measurement for a functional hemodynamic monitoring on patients suffering hemodynamic shock or instability is proposed by Spanish Critical Care Ultrasound Network Group. This algorithm considers perfusion and congestion variables. Its simplicity might be useful for guiding physicians in their daily decision-making managing critically ill patients in hemodynamic shock.

Diploma on Basic Echocardiography training and competencies for Intensive Care and Emergency medicine: Consensus document of the Spanish Society of Anesthesiology and Critical Care (SEDAR) and the Spanish Society of Emergency Medicine (SEMES)

Cardiac ultrasound has become an essential tool for diagnosis and hemodynamic monitoring in critically ill patients. Scientific societies need to work toward developing a training program that will allow clinicians to acquire competence in performing cardiac ultrasound and understanding its indications. The Clinical Ultrasound for Intensive Care task force of the Spanish Society of Anesthesiology and Critical Care (SEDAR) and the Spanish Society of Emergency Medicine (SEMES) have drawn up this position statement defining the learning objectives and training required to acquire the competencies recommended for basic ultrasound management in the intensive care and emergency setting in order to obtain a diploma in Basic Ultrasound in Intensive Care and Emergency Medicine. This document defines the training program and the competencies needed for basic skills in ultrasound in Intensive Care and Emergency Medicine-part of the Diploma in Ultrasound for Intensive Care and Emergency Medicine awarded by SEDAR/SEMES. The Spanish Society of Anesthesia (SEDAR), Spanish Society of Internal Medicine (SEMI) and Spanish Society of Emergency Medicine (SEMES) have drawn up a position statement determining the competencies and training program for a diploma in ultrasound (lung, abdominal and vascular) in Intensive Care and Emergency Medicine. To obtain the SEDAR/SEMES Diploma in Ultrasound in Intensive Care and Emergency Medicine, clinicians must have completed the SEDAR, SEMI and SEMES Diploma in basic ultrasound and the Diploma in lung, abdominal, and vascular ultrasound.

Mixed Matrix Membranes Loaded with a Porous Organic Polymer Having Bipyridine Moieties

Mixed matrix membranes (MMMs), derived from three aromatic polyimides (PIs), and an affordable porous organic polymer (POP) having basic bipyridine moieties were prepared. Matrimid and two fluorinated polyimides, which were derived from 4,4′-(hexafluoroisopropylidene)diphthalic anhydride and 2,2′-bis(4-aminophenyl)hexafluoropropane (6F6F) or 2,4,6-trimethyl-m-phenylenediamine (6FTMPD), were employed as polymer matrixes. The used POP was a highly microporous material (surface area of 805 m2 g−1) with excellent thermal and chemical stability. The MMMs showed good compatibility between the PIs and POP, high thermal stabilities and glass transition temperatures superior to those of the neat PI membranes, and good mechanical properties. The addition of POP to the matrix led to an increase in the gas diffusivity and, thus, in permeability, which was associated with an increase in the fractional free volume of MMMs. The increase in permeability was higher for the less permeable matrix. For example, at 30 wt.% of POP, the permeability to CO2 and CH4 of the MMMs increased by 4- and 7-fold for Matrimid and 3- and 4-fold for 6FTMPD. The highest CH4 permeability led to a decrease in CO2/CH4 selectivity. The CO2/N2 separation performance was interesting, as the selectivity remained practically constant. Finally, the POP showed no molecular sieving effect towards the C2H4/C2H6 and C3H6/C3H8 gas pairs, but the permeability increased by about 4-fold and the selectivity was close to that of the matrix. In addition, because the POP can form metal ion bipyridine complexes, modified POP-based MMMs could be employed for olefin/paraffin separations.

Clinical guide to perioperative management for videothoracoscopy lung resection (Section of Cardiac, Vascular and Thoracic Anesthesia, SEDAR; Spanish Society of Thoracic Surgery, SECT; Spanish Society of Physiotherapy)

The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.

Gas Permeability, Fractional Free Volume and Molecular Kinetic Diameters: The Effect of Thermal Rearrangement on ortho-hydroxy Polyamide Membranes Loaded with a Porous Polymer Network

Mixed-matrix membranes (MMMs) consisting of an ortho-hydroxy polyamide (HPA) matrix, and variable loads of a porous polymer network (PPN) were thermally treated to induce the transformation of HPA to polybenzoxazole (β-TR-PBO). Two different HPAs were synthesized to be used as a matrix, 6FCl-APAF and tBTpCl-APAF, while the PPN used as a filler was prepared by reacting triptycene and trifluoroacetophenone. The permeability of He, H₂, N₂, O₂, CH₄ and CO₂ gases through these MMMs are analyzed as a function of the fraction of free volume (FFV) of the membrane and the kinetic diameter of the gas, allowing for the evaluation of the free volume. Thermal rearrangement entails an increase in the FFV. Both before and after thermal rearrangement, the free volume increases with the PPN content very similarly for both polymeric matrices. It is shown that there is a portion of free volume that is inaccessible to permeation (occluded volume), probably due to it being trapped within the filler. In fact, permeability and selectivity change below what could be expected according to densities, when the fraction of occluded volume increases. A higher filler load increases the percentage of inaccessible or trapped free volume, probably due to the increasing agglomeration of the filler. On the other hand, the phenomenon is slightly affected by thermal rearrangement. The fraction of trapped free volume seems to be lower for membranes in which the tBTpCl-APAF is used as a matrix than for those with a 6FCl-APAF matrix, possibly because tBTpCl-APAF could approach the PPN better. The application of an effective medium theory for permeability allowed us to extrapolate for a 100% filler, giving the same value for both thermally rearranged and non-rearranged MMMs. The pure filler could also be extrapolated by assuming the same tendency as in the Robeson’s plots for MMMs with low filler content.

Feasibility and safety of transvaginal specimen extraction in deep endometriosis colorectal resectional surgery and analysis of risk factors for postoperative complications

BACKGROUND

The aim of the present study was to demonstrate that transvaginal specimen extraction is a feasible and safe approach in colorectal resection for deep endometriosis (DE) and to assess the risk factors for postoperative complications.

METHODS

This retrospective cohort study included all the consecutive patients undergoing segmental bowel resection for symptomatic endometriosis at "La Paz" University Hospital (Madrid, Spain) and at "Hospital General Universitario de Valencia" (Valencia, Spain) from January 2014 to December to 2017. Patients were grouped according to specimen extraction approach into those who had transvaginal extraction (Group I) and those who had suprapubic extraction (Group II). Clinic-demographical, surgical and post-surgical data were recorded. Intra- and postoperative complications were classified according to Clavien-Dindo criteria. Postoperative data were compared between groups. Risk factors associated with surgery were investigated.

RESULTS

Out of 99 female patients included (average age 36.91 ± 5.36 years), 23 patients (23.2%) had transvaginal and 76 (76.8%) had suprapubic specimen extraction. The groups were comparable regarding operative time, nodule size, level of anastomosis, hospital stay and intraoperative complications. We observed no statistically significant differences in postoperative complications and rectovaginal fistula rate between the groups. Binary logistic regression analyses determined that vaginal endometriosis is an independent risk factor for postoperative complications (OR: 2.63, 95% CI [1.10-6.48], p = 0.03).

CONCLUSIONS

Transvaginal specimen extraction is a safe and feasible technique in DE colorectal surgery and should be taken into consideration whenever vaginal endometriosis exists. Nevertheless, vaginal endometriosis can be an independent risk factor for postoperative complications in DE surgery.

A Systematic Study of Ammonia Recovery from Anaerobic Digestate Using Membrane-Based Separation

Ammonia recovery from synthetic and real anaerobic digestates was accomplished using hydrophobic flat sheet membranes operated with H₂SO₄ solutions to convert ammonia into ammonium sulphate. The influence of the membrane material, flow rate (0.007, 0.015, 0.030 and 0.045 m³ h⁻¹) and pH (7.6, 8.9, 10 and 11) of the digestate on ammonia recovery was investigated. The process was carried out with a flat sheet configuration at a temperature of 35 °C and with a 1 M, or 0.005 M, H₂SO₄ solution on the other side of the membrane. Polytetrafluoroethylene membranes with a nominal pore radius of 0.22 µm provided ammonia recoveries from synthetic and real digestates of 84.6% ± 1.0% and 71.6% ± 0.3%, respectively, for a membrane area of 8.6 × 10⁻⁴ m² and a reservoir volume of 0.5 L, in 3.5 h with a 1 M H₂SO₄ solution and a recirculation flow on the feed side of the membrane of 0.030 m³ h⁻¹. NH₃ recovery followed first order kinetics and was faster at higher pHs of the H₂SO₄ solution and recirculation flow rate on the membrane feed side. Fouling resulted in changes in membrane surface morphology and pore size, which were confirmed by Atomic Force Microscopy and Air Displacement Porometry.

Consumers' growing appetite for natural foods: Perceptions towards the use of natural preservatives in fresh fruit

Recent changes in food purchasing and consumption have led consumers to place greater importance on aspects such as convenience and the impact of food production and processing on health and the environment. This, in turn, poses a challenge for the food industry, especially with respect to highly perishable foods such as fruit. Great efforts have been made by the industry to reduce post-harvest losses by using natural preservatives that can replace traditional chemical fungicides, which are increasingly rejected by both citizens and governments. In this context, the purpose of this study was to obtain an overview of consumer perceptions towards the application of these novel products in fruit. In order to achieve this goal, five focus group sessions were held in multiple Spanish cities from December 2019 to February 2020. A total of 48 people with a mixed socio-demographic background took part in the study. The results showed both positive and negative consumer perceptions towards fruit, on the one hand being healthy and natural, and on the other lacking convenience. Packaging increases fruit convenience at the cost of its perception as a natural food product. In addition, consumers reported negative opinions associated with both the use of chemicals to improve fruit preservation and the environmental impact of the packaging. Participants showed interest in the use of natural preservatives in fruit, as these are considered more natural, healthier and more environmentally friendly. Although natural preservatives can influence consumers' fruit purchasing decisions, lack of information about such preservatives can cause doubts about their effectiveness and misjudgements about the price premium they add. Therefore, information about these types of preservatives, their characteristics and their benefits is key to overcoming mistrust and communicating to consumers the differentiation that their use adds to foods.

Past, Present and Future of Membrane Technology in Spain

The following review aims at analyzing the contribution of Spanish researchers to membrane science and technology, with a historical compilation of the main milestones. We used a bibliometric analysis based on the Scopus database (1960–2020) dealing with 8707 documents covering the different disciplines and subject areas where membranes are involved. Furthermore, the information has been updated to the present moment of writing this manuscript in order to include the latest research lines and the different research groups currently active in Spain, which may lead the way to the development of the field in the coming years.

P14.58 Efficacy and safety of lomustine versus fotemustine as first and second line treament in relapsed glioblastoma patients

BACKGROUND

Glioblastoma (GB) is the most aggressive primary brain tumour. Despite the survival benefit associated with adjuvant therapy, most of patients (pts) relapse after initial therapy. Nitrosoureas (NU) are the standard treatment at relapse in Europe. Both fotemustine (FM) (Addeo schema) and lomustine (LM) (administered orally every 6 weeks) are used in this context.

MATERIAL AND METHODS

This retrospective cohort study included pts diagnosed with GB treated with NU at relapse in four Catalonia hospitals from 2010 to 2020. Clinical and pathological data were collected from medical records. We analysed 6months-progression-free survival (6m-PFS), progression-free survival (PFS) and overall survival (OS) from the start of NU to progression or death respectively. Differences in toxicity grade using CTCAE v5.0 were analysed globally as ‘non-toxicity’, ‘mild toxicity (grade 1 or 2)’ and ‘high toxicity (grade 3 or 4)’.

RESULTS

We identified 236 GB pts with a median age of 58 years old. 29% of the pts presented MGMT promotor methylation and only 3%(n=7) had IDH mutation. After a median follow-up of 20 months, 94% of the pts were dead at the time of the analyses. At first line, 83 pts were treated with FM and 18 with LM. Pts treated with FM had better performance status (PS) than those treated with LM (p=.010). Median PFS was 2 months and 6m-PFS was 12% vs 6% in FM and LM group respectively (p=.87). Median OS was 3 months with LM vs 6 months with FM, with no statistically significant differences even adjusted for prognostic factors (p=.79 HR:0.9 CI 95% 0.41–1.96).At second line, 78 were treated with FM and 24 with LM, no differences between groups. Median PFS was 2 months in both groups and median OS was 3 vs 5 months for pts treated with LM vs FM respectively, with no significant differences. 6m-PFS was 13% for LM vs 0% for the FM group (p=.39).Pts received a mean of 1.7 cycles (every 6 weeks) and 4.1 cycles (every 2 weeks) in LM and FM group, respectively. Thrombocytopenia was the most common serious side-effect, with a higher proportion of grade 1–2 toxicity in the FM group (p=.03) that also required more treatment delays (p=.01).

CONCLUSION

Despite being retrospective study and a few pts were treated with LM, there were no differences neither in PFS nor in OS in pts treated with LM vs FM at first or second line. Higher G1-2 thrombocytopenia was shown in the FM group probably due to a higher number of hematology samples collected.

Grado de desarrollo del folículo preovulatorio y su relación con el tamaño del cuerpo lúteo y la producción de progesterona en las razas Romosinuano (RS) y Brahman (Br)T0

Para comparar en los folículos preovulatorios de hembras bovinas de las razas Brahman (Br) y Romosinuano (rs) el desarrollo de los diferentes componentes foliculares, como el tamaño del antro folicular, el grosor y el volumen ocupado por la capa de células de la granulosa (cg) y de la teca interna (ti), y su posible relación con el desarrollo del cuerpo lúteo (cl) y la producción de progesterona P4, se utilizaron 5 hembras de la raza rs y 5 de la raza Br. A estas se les realizó seguimiento ecográfico durante 2 ciclos estrales y se les efectuó muestreo de suero sanguíneo para determinar por Elisa los niveles de P4. En el tercer estro se les extirpó el ovario que contenía el folículo preovulatorio y se realizó un corte diametral sobre el estigma del folículo para seccionarlo en 2 partes iguales. En una de las partes se hicieron cortes histológicos y se determinó la morfometría folicular. La duración del ciclo estral en las hembras de la raza Br osciló entre 18 y 21 días, con promedio de 19,9 ± 1,6 días, y en las vacas rs entre 18 y 24 días, con un promedio 21,2 ± 1,69 días. La duración del estro fue de 13,9 ± 6,98 y 9,60 ± 4,72 h para las razas rs y Br, respectivamente. El intervalo estro-ovulación fue de 21,20 ± 5,07 h para los animales de la raza Br y de 24,40 ± 6,43 para los rs. No se registraron diferencias entre razas ni en el grosor (rs: 55,12 ± 6,46 µm vs. Br: 49,48 ± 17,07 µm), p > 0,05, tampoco en el volumen ocupado por la capa de cg (rs: 27,93 ± 6,11 mm3 vs. Br: 25,40 ± 13,85 mm3) de los folículos preovulatorios p < 0,05, en el grosor (rs: 122,50 ± 20,53 µm vs. Br: 129,61 ± 84,85 µm) o en el volumen (rs: 64,97 ± 19,71 mm3 vs. Br: 59,83 ± 25,67 mm3) de las células de la ti. El máximo desarrollo de los cl para la totalidad de las hembras se alcanzó el día 12,6 ± 4,05 (día 0 = estro), con un diámetro promedio de 22,92 ± 3,60 mm. Para las de la raza rs el diámetro máximo fue 23,06 ± 3,9 mm y se observó en promedio el día 14,88 ± 3,4. Para las de la raza Br fue el día 10,00 ± 3,16 con un promedio de 22,75 ± 3,16 mm. En ese día, la concentración media de P4 fue de 5,37 ± 1,38 ng/ml para la raza rs y 5,74 ± 0,89 ng/ml para la raza Br. No se presentaron diferencias significativas entre razas (p > 0,05). Se concluyó que no existen diferencias en los eventos fisiológicos estudiados entre las razas rs y Br. Los hallazgos del presente estudio, sin duda, pueden servir de base para futuros análisis en los bovinos residentes en el trópico.

Clinical guide to perioperative management for videothoracoscopy lung resection (Section of Cardiac, Vascular and Thoracic Anesthesia, SEDAR; Spanish Society of Thoracic Surgery, SECT; Spanish Society of Physiotherapy)

The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.

Mycorrhizal-Assisted Phytoremediation and Intercropping Strategies Improved the Health of Contaminated Soil in a Peri-Urban Area

Soils of abandoned and vacant lands in the periphery of cities are frequently subjected to illegal dumping and can undergo degradation processes such as depletion of organic matter and nutrients, reduced biodiversity, and the presence of contaminants, which may exert an intense abiotic stress on biological communities. Mycorrhizal-assisted phytoremediation and intercropping strategies are highly suitable options for remediation of these sites. A two-year field experiment was conducted at a peri-urban site contaminated with petroleum hydrocarbons and polychlorinated biphenyls, to assess the effects of plant growth (spontaneous plant species, Medicago sativa, and Populus × canadensis, alone vs. intercropped) and inoculation of a commercial arbuscular mycorrhizal and ectomycorrhizal inoculum. Contaminant degradation, plant performance, and biodiversity, as well as a variety of microbial indicators of soil health (microbial biomass, activity, and diversity parameters) were determined. The rhizosphere bacterial and fungal microbiomes were assessed by measuring the structural diversity and composition via amplicon sequencing. Establishment of spontaneous vegetation led to greater plant and soil microbial diversity. Intercropping enhanced the activity of soil enzymes involved in nutrient cycling. The mycorrhizal treatment was a key contributor to the establishment of intercropping with poplar and alfalfa. Inoculated and poplar-alfalfa intercropped soils had a higher microbial abundance than soils colonized by spontaneous vegetation. Our study provided evidence of the potential of mycorrhizal-assisted phytoremediation and intercropping strategies to improve soil health in degraded peri-urban areas.

Treatment of advanced-stage canine nasal carcinomas with toceranib phosphate: 23 cases (2015-2020)

OBJECTIVE

To determine the median survival time (MST) of dogs with nasal carcinoma treated with toceranib phosphate.

MATERIAL AND METHODS

The databases of four Spanish referral hospitals were retrospectively searched for dogs with a diagnosis of nasal tumours presented between January 2015 and October 2020. Dogs treated with radiotherapy or other chemotherapies prior toceranib were excluded.

RESULTS

Twenty-three dogs with a confirmed nasal carcinoma treated with toceranib phosphate and with a CT scan for initial staging according to Adams Modified Staging System were included. Nine dogs had a stage III nasal carcinoma whereas 14 dogs had a stage IV nasal carcinoma. No dog had stages I and II nasal carcinoma. The median overall survival time was 139 days. The difference between the MST between dogs with stages III and IV was not statistically significant [P = 0.6, 140 days for stage III (range 46-401) vs 120 days for stage IV (range 23-600)]. Overall, dogs with epistaxis achieved a longer median survival (166 days) than dogs without epistaxis (83 days). Toceranib phosphate was generally well tolerated. Most dogs had an initial clinical benefit followed by progressive disease.

SIGNIFICANCE

This is the first study to report the MST in dogs with stages III and IV nasal carcinoma treated with toceranib phosphate. This retrospective study showed that toceranib phosphate decreases the clinical signs associated with nasal carcinomas.

Tunable Waveguides Couplers Based on HPDLC for See-Through Applications

Photopolymers have become an important recording material for many applications, mainly related to holography. Their flexibility to change the chemical composition together with the optical properties made them a versatile holographic recording material. The introduction of liquid crystal molecules in a photopolymer based on multifunctional monomer provides us the possibility to generate tunable holograms. The switchable holographic elements are a key point for see-through applications. In this work, we optimize the holographic polymer-dispersed liquid crystals composition to improve the performance of tunable waveguide couplers based on transmission gratings and specifically their response under an applied electric field. A variation around 60% in the transmission efficiency was achieved.

AB0542 EVALUATION OF APREMILAST USE IN THE ROUTINE CLINICAL PRACTICE IN PATIENTS WITH PSORIATIC ARTHRITIS NAÏVE TO BIOLOGICAL TREATMENTS

Background:

Apremilast is a non-biologic systemic agent approved for the treatment of plaque psoriasis, oral ulcers of Behcet’s disease and PsA with proven efficacy in clinical trials [1,2]. However, more real-world evidence of apremilast use and effectiveness is needed to identify the patient profile most likely to benefit from this treatment [3].

Objectives:

To evaluate the persistence of apremilast treatment in patients with PsA naïve to biological treatments in routine clinical practice and assess its effectiveness. Baseline clinical characteristics on patients who started apremilast were also evaluated.

Methods:

Observational, prospective, multicenter (20 centers) study including consecutive adult patients with PsA naïve to biological therapies who had started treatment with apremilast during the previous 5 to 7 months and were followed-up during 12 months. Variables recorded were persistence of treatment with apremilast at 6 months (6mo) and number of swelling joints, presence of enthesitis and dactylitis, and disease activity, measured by the Disease Activity in Psoriatic Arthritis (DAPSA) score and Physician Global Assessment (PGA) of psoriasis, collected at baseline (BL) (i.e., apremilast treatment start) and 6mo; comorbidities were retrospectively collected at BL. Categorical and quantitative variables were compared using McNemar’s and Wilcoxon test, respectively. Data sets analyzed included all assessable patients.

Results:

Of the 60 patients recruited at the time of this interim analysis, 54 (90.0%) [mean (SD) age 53.4 (13.9) years] were assessable; 41 (75.9%) of these continued treatment with apremilast at 6mo. At BL, 34 (63.0%) patients had at least one comorbidity, the most frequent being cardiovascular disease (n=15, 27.8%), including hypertension (n=8, 14.8%), metabolic/endocrine disease (n=18, 33.3%), including obesity (n=8, 14.8%) and dyslipidemia (n=10, 18.5%). Psychiatric disease (i.e., depression) (n=5, 9.3%) and neoplasia (n=8, 14.8%) were also observed. The number of swelling joints decreased from median (Q1, Q3) 4.0 (2.0, 7.0) at BL to 1.5 (0.0, 4.0) at 6mo (p=0.0012). Patients with dactylitis and enthesitis decreased from 19 (35.2%) and 16 (29.6%) at BL to 10 (18.5%) and 9 (16.7%) at 6mo (p=0.0225 and p=0.0391), respectively. The distribution of patients in the different disease activity categories according to DAPSA scale changed between BL and 6mo, indicating a favorable disease evolution (Figure 1 next page). According to PGA, at BL (n=53), disease activity was categorized as mild in 18.0%, as moderate in 72.0%, and as severe in 10% of patients and, at 6mo (n=54), as mild in 70.6%, as moderate in 25.5%, and as severe in 3.9% of patients. Fifteen (27.8%) patients interrupted treatment permanently (n=13, 24.1%) or temporarily (n=2, 3.7%), due to no/partial response (n=8, 14.8%), tolerability issues leading to adverse events (n=3, 5.6%), patient decision (n=2, 3.7%), and other reasons (n=2, 3.7%) after a mean (SD) treatment of 3.05 (2.20) months.

Conclusion:

Forty-one (75.9%) patients with PsA naïve to biological therapies were treated with apremilast during ≥6 months. After treatment, the number of swelling joints, and dactylitis and enthesitis decreased and changes in disease activity according to DAPSA and PGA pointed to a favorable disease evolution. Apremilast treatment provides a clinical benefit to patients with PsA treated in clinical practice.

References:

[1]Gossec L, Smolen JS, Ramiro S, et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis. 2016 Feb 10;75(3):499 LP-510

[2]Torres T and Puig L. Apremilast: A novel oral treatment for psoriasis and psoriatic arthritis. Am J clin Dermatol. 2018 Feb;19(1):23-32

[3]Coates LC, Kavanaugh A, Mease PJ et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015. Treatment Recommendations for Psoriatic Arthritis. Arthritis Rheumatol. 2016;68(5):1060– 71.

Disclosure of Interests:

Jordi Gratacos-Masmitja Speakers bureau: MSD, Pfizer, AbbVie, Janssen Cilag, Novartis, Celgene y Lilly., Consultant of: MSD, Pfizer, AbbVie, Janssen Cilag, Novartis, Celgene y Lilly., José Luis Álvarez Vega Speakers bureau: Abbvie, Amgen, MSD, Lilly, Roche, Esteve, UCB, Menarini, Pfizer, GSK, BMS, Janssen, Novartis, Gebro., Consultant of: Abbvie, Amgen, MSD, Lilly, Roche, Esteve, UCB, Menarini, Pfizer, GSK, BMS, Janssen, Novartis, Gebro., Grant/research support from: Abbvie, Amgen, MSD, Lilly, Roche, Esteve, UCB, Menarini, Pfizer, GSK, BMS, Janssen, Novartis, Gebro., Emma Beltrán Speakers bureau: Abbvie, Bristol, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Consultant of: Abbvie, Bristol, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, ANA URRUTICOECHEA-ARANA: None declared., C. Fito-Manteca: None declared., Francisco Maceiras: None declared., Joaquin Maria Belzunegui Otano Speakers bureau: Lilly, Amgen, Novartis, Abbvie, Janssen., J. Fernández-Melón Speakers bureau: Amgen SL, Eugenio Chamizo Carmona: None declared., Abad Hernández Speakers bureau: MSD, Abbvie, Pfizer, Kern, Novartis, Biogen, Sandoz, Amgen, Sanofi, Lilly, Roche and Janssen-Cilag, Consultant of: MSD, Abbvie, Pfizer, Kern, Novartis, Biogen, Sandoz, Amgen, Sanofi, Lilly, Roche and Janssen-Cilag, Grant/research support from: MSD, Abbvie, Pfizer, Kern, Novartis, Biogen, Sandoz, Amgen, Sanofi, Lilly, Roche and Janssen-Cilag, Inmaculada Ros Consultant of: Amgen, Grant/research support from: MSD, Roche, Novartis, lilly, Pfizer, Amgen, Eva Pascual Shareholder of: Amgen, Employee of: Amgen, Juan Carlos Torre Speakers bureau: Amgen, Lilly, Novartis, Janssen, Pfizer, Consultant of: Amgen, Lilly, Novartis, Janssen, Pfizer, Grant/research support from: Amgen, Lilly, Novartis, Janssen, Pfizer.

POS0996 SIX-YEAR RESULTS FROM THE ESPERANZA COHORT: EVALUATION OF CLINICAL FEATURES, DISEASE ACTIVITY MEASURES AND TREATMENT ASPECTS IN AXIAL AND PERIPHERAL EARLY SPONDYLOARTHRITIS

Background:

Esperanza was a multicenter national health program developed to facilitate an early diagnosis of patients with Spondyloarthritis (SpA) in Spain.

Objectives:

To compare the clinical evolution of patients with axial SpA (axSpA) and peripheral SpA (pSpA) included in this program.

Methods:

Patients from the Esperanza cohort fulfilling ASAS criteria for axSpA or pSpA and completed the 6-year follow-up were included. Patients were classified according to the predominant symptom. In case of having axSpA and pSpA, they were classified as axSpA. Clinical features, disease activity and treatment aspects at baseline and 6-year visit were evaluated.

Results:

From 775 patients recruited at baseline, 6-year follow-up data from 178 (83.5%) fulfilling ASAS criteria at the final visit were available: 133 (74.7%) for axSpA and 45 for pSpA (25.3%). 118 (66.3%) were males (50.6% with axSpA and 62.2%, pSpA, p=0.4). Patients with axSpA had more frequently positive HLA-B27 (90.5%) vs. (9.5%), p<0.001. Follow-up clinical features are shown in Table 1. At the final visit, both axSpA and pSpA presented an improvement in clinical symptoms, disease activity (CRP, BASDAI, ASDAS and VAS-pt) and quality of life (ASQoL). A worsening of mobility (BASMI) was observed in both groups. The prevalence of uveitis, psoriasis and inflammatory bowel disease (IBD) at baseline was 10.7%, 18% and 5.6%, respectively. At the 6-year visit, the cumulative prevalence (CP) was 14% for uveitis (16.5% in axSpA and 6.7% in pSpA), 22.5% for psoriasis (12.8% in axSpA and 51.1% in pSpA) and 7.9% for IBD (5.3% in axSpA and 15.6% in pSpA). Most of the patients were prescribed NSAIDS at baseline and more patients maintained this treatment at the 6-year visit in axSpA compared with pSpA (96.9% vs 87.5%, p=0.02). At the final visit, a higher percentage with pSpA received csDMARDs in comparison with axSpA (81% vs. 35.7%, p<0.001). Sixty (44.4%) patients received biologic therapy at the final visit and no differences were observed in their prescription: 43% in axSpA and 48.6% in pSpA(p=0.6).

Conclusion:

The early diagnosis of recent-onset SpA achieves a significant improvement in clinical features, disease activity and quality of life in patients with axSpA and pSpA after 6 years of follow-up. Although previous publications revealed a low radiographic progression in this cohort1, the worsening of BASMI must aware clinicians of possible evolutive structural damage.

Reference:

[1]Fernández-Carballido et al. RMD Open. 2020 Sep;6(2):e001345

Acknowledgements:

The Spanish Foundation of Rheumatology received funding from Pfizer (formerly Wyeth) to develop the Esperanza Program. Later, the Program has been supported by restricted grants from the Instituto de Salud Carlos III and Fondos FEDER (FIS PI13/02034 and PI17/01840) and AbbVie.

Disclosure of Interests:

Carolina Tornero: None declared, Victoria Navarro-Compán: None declared, Beatriz Joven-Ibáñez: None declared, RAQUEL ALMODOVAR: None declared, Xavier Juanola-Roura: None declared, Cristina Fernández-Carballido: None declared, Juan Carlos Quevedo-Abeledo: None declared, Jose Rosas: None declared, Azucena Hernández: None declared, Carlos A. Montilla-Morales: None declared, Jose Ramón Maneiro: None declared, A. Juan-Mas: None declared, Jose Antonio Pinto Tasende: None declared, Mireia Moreno: None declared, Jesus Sanz: None declared, Teresa Ruiz Jimeno: None declared, Manuel Moreno: None declared, María Lourdes Ladehesa Pineda: None declared, Eugenio de Miguel Speakers bureau: AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi., Paid instructor for: Janssen, Novartis, Roche, Consultant of: AbbVie, Novartis, Pfizer, Galapagos, Grant/research support from: Abbvie, Novartis, Pfizer.

Gestión de la calidad en tiempos de Covid-19: Nueva metodología de trabajo en Investigaciones Agropecuaria del Centro de Ingeniería Genética y Biotecnología, Cuba

Los Sistemas de Gestión de Calidad (SGC) se utilizan en las empresas biotecnológicas especialmente en las áreas de investigaciones para gestionar los proyectos. La pandemia de la Covid-19 ha provocado un impacto en la manera de aplicar los SGC. Este reporte resume los cambios en la gestión de los proyectos en el área de las Investigaciones Agropecuarias del CIGB. Se diseñó una nueva metodología de trabajo, encaminada a potenciar la introducción de los cultivos transgénicos en la producción de alimentos, en tiempos de Covid. Como resultado principal, la reorganización en el trabajo bajo las normas de los SGC, permitió que los proyectos de mayor relevancia económica para el país cumplimentaran los objetivos estratégicos propuestos.

Effect of Blood Flow on Hemoglobin and Myoglobin Oxygenation in Contracting Muscle Using Near-Infrared Spectroscopy

Insufficient O₂ delivery to, and uptake by skeletal muscle can produce mobility limitations for patients with chronic diseases. Near-infrared spectroscopy (NIRS) can be used to noninvasively quantify the balance between skeletal muscle O₂ delivery and utilization during contraction. However, it is not clear how the oxygenated or deoxygenated NIRS signal should be used to assess muscle O₂ changes. This issue is related to the fact that the contributions of hemoglobin (Hb) and myoglobin (Mb) cannot be distinguished. This conundrum can be resolved by quantitative analysis of experimental data by computer simulations with a mechanistic, mathematical model. Model simulations distinguish dynamic responses of the oxygenated (HbO₂, MbO₂) and deoxygenated (HHb, HMb) contributions to the NIRS signal components (HbMbO₂, HHbMb). Simulations of muscle O₂ uptake and NIRS kinetics correspond closely to published experimental data (Hernández et al., J Appl Physiol 108: 1169-1176, 2010). Simulated muscle O₂ uptake and oxygenation kinetics with different blood flows indicate (1) faster O₂ delivery is responsible for slower muscle oxygenation kinetics; (2) Hb and Mb contributions to the HbMbO₂ are similar (40-60%); and (3) Hb and Mb contributions to the HHbMb are significantly different, 80% and 20%, respectively. The effect of slow blood flow kinetics on oxygenated Hb and Mb contributions is minimal. However, the effect on the imbalance between O₂ delivery and utilization rates causes significant overshoots and undershoots of deoxygenated Hb and Mb contributions. Model analysis in combination with NIRS measurements and information on hemodynamic and microvascular distribution can help to determine the use of NIRS signal in evaluating the factors limiting exercise tolerance in health and disease states.

Community treatment for adolescents with mental health problems

Introduction

This is the case of a 15-year-old boy who had been socially isolated in his house for over 1 year. He had become increasingly agitated, but refused any help offered.

Objectives

To establish the role of community treatment in adolescents with mental health problems.

Methods

Summary of the interventions taken place during the treatment

Results

Initially this young person refused any medical treatment, so we tried first supportive therapy and CBT. He dicho not obtain any benefits as he appeared experiencias paranoid ideation and thoughts of being persecuted in the streets. With support from the occupational therapist, the young person started to take care of his personal hygiene. Afterwards he started to take oral medication with partial response. We decided to switch to im treatment. In conjunction with CBT, the young person was gradually able to llaves the house. All the sessions during the first few months took place at his family home. These visits were weekly or twice weekly. Once he left the house, he attended the grupos at the day hospital. After 18 months, he was discharged without medication and he is currently studying for a degree.

Conclusions

Community treatment in adolescent with mental health problems is a better opción to establish good rapport and avoid stressful situations that could take place in an in-patient facilita.

Disclosure

No significant relationships.

Gas Separation by Mixed Matrix Membranes with Porous Organic Polymer Inclusions within o-Hydroxypolyamides Containing m-Terphenyl Moieties

A hydroxypolyamide (HPA) manufactured from 2,2-bis(3-amino-4-hydroxy phenyl)-hexafluoropropane (APAF) diamine and 5′-terbutyl-m-terphenyl-4,4′′-dicarboxylic acid chloride (tBTpCl), and a copolyimide produced by stochiometric copolymerization of APAF and 4,4′-(hexafluoroisopropylidene) diamine (6FpDA), using the same diacid chloride, were obtained and used as polymeric matrixes in mixed matrix membranes (MMMs) loaded with 20% (w/w) of two porous polymer networks (triptycene-isatin, PPN-1, and triptycene-trifluoroacetophenone, PPN-2). These MMMs, and also the thermally rearranged membranes (TR-MMMs) that underwent a thermal treatment process to convert the o-hydroxypolyamide moieties to polybenzoxazole ones, were characterized, and their gas separation properties evaluated for H₂, N₂, O₂, CH₄, and CO₂. Both TR process and the addition of PPN increased permeability with minor decreases in selectivity for all gases tested. Excellent results were obtained, in terms of the permeability versus selectivity compromise, for H₂/CH₄ and H₂/N₂ separations with membranes approaching the 2008 Robeson’s trade-off line. The best gas separation properties were obtained when PPN-2 was used. Finally, gas permeation was characterized in terms of chain intersegmental distance and fraction of free volume of the membrane along with the kinetic diameters of the permeated gases. The intersegmental distance increased after TR and/or the addition of PPN-2. Permeability followed an exponential dependence with free volume and a quadratic function of the kinetic diameter of the gas.

Diploma on Ultrasound training and competency for Intensive Care and Emergency Medicine: Consensus document of the Spanish Society of Anesthesia (SEDAR), Spanish Society of Internal Medicine (SEMI) and Spanish Society of Emergency Medicine (SEMES)

The use of ultrasound as a clinical diagnostic tool and guide of bedside procedures has become an indispensable examination in the acute critically ill patient. The training of professionals in minimum skills of knowledge, management and indications of use of ultrasound required to be defined by the Scientific Societies. The Intensive Care Ultrasound Working Group of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Emergency Medicine (SEMES) has developed this consensus document in which the recommended training program and the minimum competencies to be achieved with regard to the use of Ultrasound in Intensive Care, Anesthesia and Emergency medicine are defined. This document defines the training program and the skills to acquire in order to achieve the diploma in lung, abdominal and vascular ultrasound. This document can serve as a guide to define the skills to be acquired in the training programs of residents (MIRs) of specialists working in intensive care, anesthesia, and emergency medicine.

Factors affecting nitrification with nitrite accumulation in treated wastewater by oxygen injection

This work provides information on nitrification with nitrite accumulation in low strength ammonia (below 50 mg L^-1 NH₄-N) and low organic matter (below 150 mg L^-1 COD) reclaimed wastewater. In the South Tenerife reclaimed wastewater pipeline (62 km long), injection of O₂ has been applied to promote a nitrification process in order to improve water quality and to avoid anaerobic conditions. Nitrification occurs, in most cases, with nitrite accumulation. The amount of oxidized nitrogen compounds produced increases with the oxygen dose applied. The nitrification process is usually favoured instead of the organic matter transformation, due to the low organic matter/ammonia nitrogen ratio of water. The influence of organic matter content on nitrification has been analysed, and a good suitability for COD has been found as an indicator for nitrification limitation (for the range of COD and NH₄-N concentrations of the system). Nitrification limitation has been observed above 85 mg L^-1 COD, and nitrification inhibition above a concentration of 105 mg L^-1. In addition, the limitation of nitrite oxidation bacteria activity (nitrite accumulation) by free ammonia and temperature has been assessed, finding that, for the range of free ammonia (0.6-2.1 mg L^-1 NH₃) and temperature (20.4-27.0°C) in the study, temperature plays a much more relevant role than free ammonia on nitrite accumulation. The lower limiting temperature for nitrite build-up in the system has been 21.0°C. Below this temperature, nitrite accumulation did not exist or was very low.

[How to organize a Fetal Medicine Unit in the context of COVID-19 pandemic. Safe measures for obstetric scans and equipment cleaning]

During a pandemic, the three basic principles are. to prioritize medical resources, ensure patients' lockdown in order to avoid community transmission and prevent healthcare collapse, and keep the number of visits to an absolute minimum to avoid patient exposure and safeguard healthcare workers. Antenatal care must be maintained during a health crisis, regardless of the COVID-19 state of alert. Routine and specialist obstetric ultrasound scans are essential for clinical decision-making during pregnancy, as it has a direct impact on the management of mothers and fetuses and on the perinatal outcome. In an attempt to minimize in-person visits, these will be organized according to the established ultrasound schedule. Based on scientific evidence, and on existing main national and international guidelines, this document has been prepared, in which proposals and options are provided for managing pregnant women in the context of the SARS-CoV-2 pandemic. It includes how a Fetal Medicine Unit facing this health crisis should be restructured, what safety measures should be followed in the performance of obstetric scans and invasive procedures, and how ultrasound rooms, equipment and transducers should be cleaned and disinfected. These recommendations should be adapted to different units based on their resources and infrastructure.

Intraoperative transesophageal echocardiography in cardiovascular surgery. Consensus document from the Spanish Society of Anesthesia and Critical Care (SEDAR) and the Spanish Society of Endovascular and Cardiovascular Surgery (SECCE)

Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions.