Spatial distribution and pollution evaluation in dry riverbeds affected by mine tailings

The objective of this study was to evaluate the level of pollution, sources and potential risk of heavy metals (Zn, Cu, Mn, Cd, Cr, Ni, Fe and Pb) and arsenic (As) in four dry riverbeds affected by mine tailing, which drain into one of the biggest coastal lagoon of Europe (Mar Menor). El Beal, La Carrasquilla, Las Matildes and Ponce dry riverbeds sediments were sampled along its course (20, 18, 13, 19 samples were collected, respectively), and total/soluble metal(loid)s, water soluble ions, nitrogen, and organic/inorganic carbon contents were analyzed. Spatial distribution, principal component analysis (PCA), hierarchical cluster analysis (HCA), contamination factor (Cf), pollution load index (PLI) and potential ecological risk index (RI) were used to identify the possible sources of metal(loid)s and to assess the sediment pollution status. The results showed that the mean total concentrations of As, Cu, Cd, Mn, Zn and Pb exceeded the natural background levels of the study area, with the highest values located close to the mining areas. Correlation and cluster analysis identified that Cd and Zn were associated mainly with anthropogenic activities for all riverbeds, while Cr and Ni come from parent. PLI graded the four riverbeds as contaminated by heavy metals, while RI manifested that 100% of samples located in El Beal, La Carrasquilla and Las Matildes had a significantly high ecological risk. Therefore, this study suggests that mine wastes are the main source of metal(loids) contamination in the dry riverbeds, which results can be used to design actions and measures to reduce the environmental impact of metal(loid)s in the Mar Menor coastal lagoon.

Simultaneous determination of 210Pb and 90Sr and 210Po isolation in sludge samples using a plastic scintillation resin

This study describes a new and fast method for separating ²¹⁰Po from ²¹⁰Pb and ⁹⁰Sr, before simultaneously measuring the individual activities of the latter two radionuclides using a plastic scintillation resin (PSresin) in sludge samples taken from a drinking water treatment plant. This method speeds up the analysis process significantly by simultaneously measuring ²¹⁰Pb and ⁹⁰Sr in a single step. The method is reproducible and has a relative standard deviation of less than 25% for ²¹⁰Pb, ²¹⁰Po and ⁹⁰Sr. The method was satisfactorily validated with an intercomparison sample and applied to sludge samples from a drinking water treatment plant. The minimum detectable activities for 0.9 g of sludge are 5.5 Bq/kg and 8 Bq/kg for ²¹⁰Pb and ⁹⁰Sr respectively when measured for 180 min, and 0.5 Bq/kg for ²¹⁰Po when measured for 5000 min.

Prediabetes is more than a pre-disease: additional evidences supporting the importance of its early diagnosis and appropriate treatment

AIM

To identify Prediabetes (PreD) as early and serious diabetes step using clinical-biochemical characteristics in the population of the Primary Prevention Diabetes Buenos Aires (PPDBA) study.

METHODS

PPDBA Study evaluated benefits of adopting healthy lifestyles to prevent T2D. It recruited people 45-75 years of age with PreD (impaired fasting glycaemia [IFG], impaired glucose tolerance [IGT] or both, American Diabetes Association criteria), using an opportunistic approach. They completed a FINDRISC questionnaire, and those with a score ≥13 points were invited to participate. When they accepted, we performed an oral glucose tolerance test (OGTT) with a complete lipid profile and HbA1c while physicians completed a clinical history. We recruited 367 persons, and depending on OGTT results, the sample was divided into normals (NGT), PreD, or with diabetes (last one was excluded in our analysis). Data were statistically analyzed using parametric and nonparametric tests and logistic regression to identify parameters associated with PreD.

RESULTS

From the recruited (n = 367) 47.7% have NGT, 48.5% PreD and 3.8% unknown T2D (excluded). People with PreD were significantly older, with a higher percentage of overweight/obesity, BMI, and larger waist circumference than NGT. They also showed significantly higher fasting and 2 h post glucose load, HbA1c, and triglyceride levels. No significant differences were recorded in the blood pressure, lipid profile though both groups had abnormally high LDL-c values. They also had a larger percentage of TG/HDL-c ratios (insulin resistance indicator) (55% vs. 37.5%). Logistic regression analysis showed that PreD was significant associated with age, waist circumference, and triglyceride above target values.

CONCLUSION

Our findings showed that clinical and biochemical parameters were significantly different between people with PreD and those with NGT. This evidence supports the concept that PreD is a serious dysfunction, which should be early diagnosed and treated properly to prevent its transition to T2D and its complications.

P-652 Contribution of the D19S884 allele 8 of the FBN3 gene and the Hippo signaling to the reproductive and metabolic phenotype of PCOS patients

Study question

Does exist a correlation between the presence of D19S884 allele 8 (A8) and Hippo pathway dysregulation with the metabolic and ovarian PCOS profiles?

Summary answer

The presence of the A8 allele affects insulin resistance and hyperandrogenism. Moreover, PCOS ovarian phenotype could be related to a dysregulation of Hippo pathway genes.

What is known already

The specific D19S884 A8 allele of the FBN3 gene has been associated with an increased probability of polycystic ovarian syndrome (PCOS). D19S884 participates in FBN3 alternative splicing and produces Asprosin-3 and Fibrilin-3 proteins that may be related to PCOS clinical manifestations. Asprosin-3 has been recently identified as a glucose modulator and could be related to metabolic profiles of PCOS. Fibrilin-3 is an extracellular matrix protein, and together with a dysregulation of the Hippo pathway, could be responsible for constraining follicular growth in the PCOS ovaries.

Study design, size, duration

Descriptive and cross-sectional study with 93 women (25-37 years old) undergoing an IVF cycle between 2019 and 2021 at Hospital la Fe (Valencia, Spain). Thirty patients were considered PCOS while the remaining sixty-three were non-PCOS controls. After recruitment women were screened for A8 allele, metabolic status, hormone profile and Hippo pathway genes. The IVF cycle parameters were recorded to determine their relationship with study variables.

Participants/materials, setting, methods

Patients with two or more Rotterdam-criteria or with polycystic ovarian morphology (PCOM) were considered as PCOS. After signed informed consent, blood samples and cumulus cells were obtained at egg retrieval. Hormone and metabolic parameters were analyzed and the homeostasis model assessment of insulin resistance (HOMA-IR) established. Genomic DNA was isolated to assess the presence of A8 allele by capillary electrophoresis. The expression of Hippo pathway genes, BIRC1 and CCN2, was analyzed by Taqman qPCR assay.

Main results and the role of chance

PCOS patients showed increased body mass index (Control:23.2±3.7; PCOS:25.3±4.5, p = 0.04) antimüllerian hormone levels (Control:17.7±7.7pmol/L; PCOS:39.7±22.9pmol/L, p = 0.00), antral follicle count (Control:15±7; PCOS:27±13, p = 0.001) and a reduced number of good quality embryos (Control:1.3±0.9; PCOS:0.8±1.0, p = 0.02).

The A8 allele was detected in 15% of the recruited patients, with a 13% incidence in controls and 19% in PCOS. Interestingly, PCOS A8+ patients presented the PCOM phenotype. Women with the A8 allele (A8+) showed higher DHEAS levels (A8-:1899.7±1256.9; A8+:2642.5±555.2, p = 0.046) and free androgen index (A8-:1.1±0.8; A8+:2.0±1.2, p = 0.046) when compared to A8- ones. Similar results were obtained when the comparison was made according to clinical diagnose (Control A8+ vs. Control A8- and PCOS A8+ vs PCOS A8-). Moreover, the overall A8+ patients associated an increase in glucose levels (A8-:85.7±10.9mg/dL; A8+:93.0±6.01mg/dL, p = 0.02) and HOMA-IR (A8-:1.7±1.1; A8+:2.5±1.2). These metabolic findings were observed in control women with the allele but not in PCOS.

The PCOS group showed a downregulation of CCN2 (Fold-change (FC): -3.8±9.1, p = 0.02) in cumulus cells. Interestingly, those women with the A8 allele showed downregulated BIRC1 levels (FC A8+: -2.7±4.8 and A8-: 0.2±2.7; p = 0.04). These gene dysregulations could be related with a deficient oocyte-cumulus communication, abnormal follicular growth and an ovarian stroma stiffness alteration.

Limitations, reasons for caution

These promising results need to be confirmed in a larger population of PCOS to allow validation of the observed effects according to PCOS sub-phenotypes. Moreover, transcriptomic analysis and functional enrichment assays should be carried out to clarify the contribution of Hippo pathway and A8 allele to PCOS pathogenesis.

Wider implications of the findings

The obtained results suggest that the presence of the A8 allele influences the metabolic profile related to insulin resistance and androgen levels, as well as the activation status of Hippo pathway. Moreover, this signaling pathway seems to be dysregulated in PCOS patients, suggesting its possible role in the ovarian phenotype.

Trial registration number

Not applicable

Osteoporotic patients treated with bisphosphonates do not show the increased mortality observed in those untreated

INTRODUCTION

Osteoporosis has been said to be associated with increased mortality. On the other hand, it is debated whether treatment with bisphosphonates may reduce mortality in osteoporotic patients. To contribute to the clarification of these issues, we have studied in a prospective cohort the mortality in people without osteoporosis and in patients with osteoporosis, untreated or treated with bisphosphonates MATERIAL AND METHODS: At their inclusion in the cohort, four groups of participants were identified: (a) people without osteoporosis (group 1); (b) osteoporotic patients treated with bisphosphonates (group 2); (c) osteoporotic patients who refused to be treated (group 3); and (d) patients who met osteoporosis diagnostic criteria but were not treated because their risk of fracture was considered to be low (group 4). To compare all four groups, unadjusted Kaplan-Meier estimates of survivorship were obtained and they were compared using log-rank test. Hazard ratios were then estimated via Cox regression adjusting for the main confounders. A comparison among the osteoporotic groups was made by means of a Cox regression analysis performed using only these three groups, adjusting for propensity scores.

RESULTS

Two thousand six hundred and sixty-five people were included. In the unadjusted analysis, mortality in group 3 was higher than in the other groups (p < 0.001). Taking group 1 as a reference, Cox regression analysis showed the following mortality HRs for groups 2, 3, and 4 after adjusting for confounding factors: 0.82 (0.41-1.63), 1.37 (0.90-2.10), and 0.69 (0.46-1.02). In the analysis of the osteoporotic groups with the PS generated for them, and taking group 2 as a reference, the HRs were as follows: group 3, 2.38 (1.34-4.22); group 4, 1.45 (0.61-3.43).

CONCLUSION

Mortality in osteoporotic patients who refused treatment is higher than in osteoporotic patients treated with bisphosphonates. In unadjusted analysis, it was also higher than in non-osteoporotic people; however, this difference disappeared after adjustment for confounding factors.

P–446 Controlled ovarian stimulation protocols for oocyte vitrification induce differential gene expression profiles in primary tumours of breast cancer

Study question

Could controlled ovarian stimulation (COS) protocols used in fertility preservation (FP) impact on malignant cell proliferation and tumour molecular profiling of breast cancer (BC) patients?

Summary answer

Letrozole supplementation during ovarian stimulation for oocyte vitrification could be considered as a safe procedure in estrogen-dependent BC patients undergoing FP.

What is known already

High estradiol levels associated to COS could promote changes in gene expression in estrogen-positive BC tumors. Estradiol levels reached during the ovarian stimulation could aggressively promote malignant cell proliferation and cell migration to adjacent organs. Aromatase inhibitors such as letrozole, are added to standard stimulation protocols to avoid this undesirable potential side effect. Despite the reassuring clinical results achieved by using letrozole for FP in BC patients, there is still a lack of evidence regarding its impact on malignant cell behaviour. For this reason, specific molecular studies to properly evaluate safety of letrozole in this specific population are still required.

Study design, size, duration

Experimental in vivo study. Thirty 5-week-old Nude-nu female mice were divided into three different groups: BC (n = 10), BC and FSH stimulation (BC-FSH, n = 10), or BC and letrozole stimulation (BC-LTZ, n = 10). BC was considered the control group, whereas BC-FSH and BC-LTZ represented distinct COS protocols. Hormone-dependent BC was induced in all mice. Animals were followed-up for 5 months and then euthanized to collect kidney, ovary, spleen, and liver tissues for gene expression and immunohistochemistry (IHC) analysis.

Participants/materials, setting, methods

One million of human MCF–7 BC cells were injected into the mouse left kidney capsule. Two days after xenograft, COS was induced by 10IU FSH or 1mg/ml letrozole + 10IU FSH, followed by ovarian triggering with 10IU hCG at 48h. Human BC RT2 Profiler PCR Arrays were performed to evaluate the impact of COS on tumour behaviour. BC biomarkers (Ki67, Erα, PR and HER–2) were also analyzed by IHC to validate gene expression results.

Main results and the role of chance

The differential gene expression was firstly assessed in kidney samples, as they represent the xenograft site, and different expression profiles were obtained depending on the COS protocol used. The BC-FSH group showed a global over-expression pattern of all genes of the array when compared to BC and BC-LTZ. Further gene ontology analysis revealed that cellular process, biological regulation, metabolic process, and proteases were the most over-represented biological terms, with a 20.5-fold over-expression for MMP2 compared to the other groups. On the other hand, BC-LTZ mice presented gene expression profiles similar to that of controls. When other tissues were analysed to detect malignant cell presence, our results revealed a significant up-regulation of matrix-proteases, cell cycle and proliferation related-genes, in liver samples from the BC-FSH group, but no amplification of any of the studied genes was detected in ovarian tissue or spleen. IHC findings confirmed the presence of human BC cells in 100% of samples from kidney tissue and in 30% of samples from liver tissue in the BC-FSH group. No human cells were detected by IHC in the BC and BC-LTZ groups.

Limitations, reasons for caution

Since this is an animal model of estrogen-dependent BC induced through a cell line, further validation with human tumour breast cancer samples would be required.

Wider implications of the findings: Adjuvant letrozole in COS protocols prevents BC cell migration. The present study suggests that this protective effect could be mediated by interfering ER-pathway downstream genes involved in cell proliferation and matrix digestion. Altogether, letrozole could safely be used as a supplement during COS procedures for oocyte vitrification in BC women.

Trial registration number

Not applicable

P–435 LH preserves oocyte-granulosa cell communication in mouse ovaries exposed to chemotherapy with alkylating agents

Study question

Does Luteinizing Hormone (LH) protect the follicular endowment and growth by improving oocyte-granulosa cell (GC) communication of follicles exposed to chemotherapy at the primordial stage?

Summary answer

LH treatment protects mouse primordial follicles against alkylating agents by preventing the chemotherapy-induced follicular depletion and the impairment of oocyte-GC communication during follicular growth.

What is known already

Impaired folliculogenesis is one of the most common deleterious side effects of alkylating agents in ovaries. Bidirectional communication between the oocyte and surrounding GCs is crucial for oocyte development. Therefore, defective gap junctions and reduced oocyte-derived factors compromise folliculogenesis, oocyte competence and meiotic maturation.

Previous findings reported a significant LH protection of follicular viability and meiotic potential of MII oocytes exposed to chemotherapy at primordial stage. Therefore, we aimed to investigate the LH effects on cell junctions and communication between oocyte and GCs in growing follicles derived from quiescent oocytes exposed to alkylating chemotherapy.

Study design, size, duration

Adult 6-week-old CD1 female mice were allocated to control (n = 3), chemotherapy (ChT, n = 5) and ChT+LH (n = 5) groups. Chemotherapy (120 mg/Kg of cyclophosphamide and 12 mg/Kg of busulfan) was intraperitoneally administrated to ChT and ChT+LH mice. ChT+LH animals were pretreated with 1 IU of LH, followed by a second LH dose (1 IU) along with chemotherapy 24 hours later. Control mice only received vehicle (DMSO). Mice were euthanized 30 days later to collect ovaries.

Participants/materials, setting, methods

Follicles were mechanically isolated by puncture with 30-gauge needles from frozen-thawed half-ovaries. Isolated follicles measuring ≥100µm were selected to represent the secondary and later developmental stages. Part of them were kept intact while others were decumulated by using narrow pipettes to obtain denuded oocytes (DOs), and GCs. Follicles, ODs and GCs were analyzed by qRT-PCR to evaluate key factors in oocyte-GC junctions (Cx37, Cx43, Cdh1, Cdh2, Tjp1) and communication (Gdf9, Bmp15, Bmpr2, Alk4, Alk5, Alk6).

Main results and the role of chance

Chemotherapy induced a 2.1-fold reduction in the number of total isolated follicles (p = 0.036), reducing 2.7-fold the number of primordial and primary follicles (&lt;100 µm; p = 0.034) and 1.9-fold the amount of growing follicles (≥100 µm; p = 0.036) compared to controls. LH-treated ovaries showed a 1.6-fold increase in the total follicle isolation yield when compared to ChT (p = 0.032), recovering control-like values (p=ns). This LH protection specially benefited the early-stage follicles (&lt;100 µm), where a 1.9-fold increase in the number of isolated follicles was detected compared to ChT group (p = 0.016).

Gene expression analysis of follicles (n = 168), DOs (n = 110) and GCs (from n = 153 follicles) revealed a global downregulation pattern in ChT samples for all genes, when compared to controls, with a significant fold change (FC) reduction for Gdf9 in follicles (FC: 0.36±0.16); Cx37, Cdh2 and Gdf9 in DOs (FC: 0.23±0.17, 0.09±0.03, and 0.17±0.07, respectively); and Cx37, Cx43, Gdf9 and Bmp15 in GCs (FC: 0.40±0.23, 0.17±0.07, 0.17±0.08, and 0.04±0.01, respectively). However, LH treated samples showed an overall improvement of gene expression pattern reaching control-like levels for all genes excepting for a downregulation of the Bmp15 expression in GC (FC: 0.28±0.24; p = 0.036).

Limitations, reasons for caution

Animal model study performed with a reduced sample size. Therefore, these findings should be validated in further studies with human tissue samples.

Wider implications of the findings: Our findings suggest that LH treatment prevents the chemotherapy-induced follicle depletion. The LH protection of primordial population seems to preserve its ability to properly establish oocyte-GC interactions during growth and development, which is required to regulate follicular maturation and oocyte competence.

Trial registration number

Not applicable

Long-term outcomes of spinal SBRT. Is it important to select the treatment time?

PURPOSE

SBRT (stereotactic body radiation therapy) is widely used as a curative treatment in tumoral lesions and has become a fundamental tool for the treatment of spine metastasis. In this study, we present survival and toxicity outcomes of spine SBRT after a 2-year follow-up.

METHODS/PATIENTS

Data from spine SBRT treatments performed at our institution between March 2012 and February 2020 was collected. Medical records, including demographic, primary tumor, and treatment characteristics were reviewed. Patient follow-up included clinical evaluation, imaging, and blood tests. Toxicity was recorded according to CTCAE v4.0.

RESULTS

We analyzed 73 consecutive spine SBRT treatments in 60 patients. 39.7% of the cases had primary breast cancer and 23.3% had prostate cancer. Most cases (87.7%) were treated with a single SBRT fraction of 16 Gy. Median follow-up was 26.1 months (range 1.7-78.6), and 1- and 2-year overall survival (OS) rates were 96.9% and 84.2%, respectively. Local control (LC) rates at 1- and 2-years were 76.3% and 70.6%, respectively. Multivariate analysis identified histology as a prognostic factor for both OS and LC. Patients who underwent spine SBRT 6 months after the spinal lesion diagnosis had LC at 2 years of 88%, vs 61.7% for those who underwent SBRT before this period. No grade III or higher toxicity was reported. The vertebral compression fracture (VCF) rate was 4.1%.

CONCLUSION

Spine SBRT at our institution showed a 2-year LC of 70.6%, without G3 toxicities. Delaying SBRT at least 6 months to administer systemic treatment was related to an improvement in local control.

Characteristics of Medically Transported Critically Ill Children with Respiratory Failure in Latin America: Implications for Outcomes

Several challenges exist for referral and transport of critically ill children in resource-limited regions such as Latin America; however, little is known about factors associated with clinical outcomes. Thus, we aimed to describe the characteristics of critically ill children in Latin America transferred to pediatric intensive care units for acute respiratory failure to identify risk factors for mortality. We analyzed data from 2,692 patients admitted to 28 centers in the Pediatric Collaborative Network of Latin America Acute Respiratory Failure Registry. Among patients referred from another facility (773, 28%), nonurban transports were independently associated with mortality (adjusted odds ratio = 9.4; 95% confidence interval: 2.4–36.3).

Guillain-Barre syndrome associated to COVID-19 infection: a review of published case reports

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic is a major worldwide health disorder. There is an increasing number of neurological complications recognized with COVID-19 including patients with GBS and its variants.

DEVELOPMENT

A review of the clinical cases of GBS associated to COVID-19 infection published in the last months has been developed. We included 48 patients (31 men, mean age 56.4 years). The most common COVID-19 symptoms were cough (60.4%) and fever (56.3%). Mean time from COVID-19 symptoms to neurologic manifestations was 12.1 days, but in nine patients (18.8%) developed GBS within seven days. Eleven patients (22.9%) presented cranial nerve involvement in the absence of muscle weakness; 36 presented the classic sensory motor variant (75%) and one had a pure motor variant (2.1%). The electrodiagnostic pattern was considered demyelinating in 82.4% of the generalized variants. The presence of hyposmia/dysgeusia was associated with a latency shorter than seven days to GBS onset of symptoms (30% vs 15.6%), and cranial nerve involvement in the absence of weakness (30.8% vs 17.1%). Most patients (87.5%) were treated with intravenous immunoglobulin. Neurological outcome was favorable in 64.6%; 29.2% had respiratory failure and 4.2% died shortly after being admitted.

CONCLUSIONS

GBS in patients with SARS-CoV-2 infection resembles clinically and electrophysiology the classical forms. Further studies are necessary to understand whether GBS frequency is actually increased due to SARS-CoV-2 infection and explore pathogenic mechanisms.

Characteristics and prognosis of jejunoileal gastrointestinal stromal tumours (GISTs) in the era of imatinib: a comparative study with gastric GISTs

BACKGROUND

Gastrointestinal stromal tumours (GISTs) located in the jejunum or ileum (JI-GIST) are considered worse prognosis compared to those of gastric (G-GIST) location. It has been suggested that this dogma should be revised. The aim of this study was to describe the characteristics of jejunoileal GISTs and its prognosis and to compare them with G-GISTs in the era of imatinib.

METHODS

We retrospectively reviewed the clinical histories of all the patients diagnosed with GISTs between January 2000 and November 2016: Clinical and pathological data, as recurrence, metastatic state, disease-free survival (DFS) as well as overall survival (OS) rates of patients were reviewed.

RESULTS

JI-GIST patients comprise 29 cases (37.7%). Compared to G-GIST, JI-GIST patients had undergone emergency surgery more frequently (37.9% vs. 10.4%, p = 0.007). According to the NIH-Fletcher classification, the low or very-low risk group represents 17.2% of JI-GISTs as opposed to 37.6% of G-GISTs (p < 0.005). When the AFIP-Miettinen system was used the low or very-low group represented 17.2% of JI-GISTs vs. 58.4% in the G-GISTs group (p < 0.001). Both local recurrence (24.1% vs. 12.5%, p < 0.05) and metastatic rate (34.5% vs. 22.9%, p < 0.05) were higher in the JI-GIST group than in G-GIST. 5- and 10-year DFS and 10-year OS rate were lower for JI-GIST (54.5% and 39.6% vs. 77.2% and 60.8%, and 57.9% vs. 65%, respectively, p < 0.05).

CONCLUSIONS

The observed differences between both groups in DFS and OS rates at long term could be attributed to the effect of imatinib.

Oxygen intercalation in PVD graphene grown on copper substrates: A decoupling approach

We investigate the intercalation process of oxygen in-between a PVD-grown graphene layer and different copper substrates as a methodology for reducing the substrate-layer interaction. This growth method leads to an extended defect-free graphene layer that strongly couples with the substrate. We have found, by means of X-ray photoelectron spectroscopy, that after oxygen exposure at different temperatures, ranging from 280 °C to 550 °C, oxygen intercalates at the interface of graphene grown on Cu foil at an optimal temperature of 500 °C. The low energy electron diffraction technique confirms the adsorption of an atomic oxygen adlayer on top of the Cu surface and below graphene after oxygen exposure at elevated temperature, but no oxidation of the substrate is induced. The emergence of the 2D Raman peak, quenched by the large interaction with the substrate, reveals that the intercalation process induces a structural undoing. As suggested by atomic force microscopy, the oxygen intercalation does not change significantly the surface morphology. Moreover, theoretical simulations provide further insights into the electronic and structural undoing process. This protocol opens the door to an efficient methodology to weaken the graphene-substrate interaction for a more efficient transfer to arbitrary surfaces.

Fontan protein-losing enteropathy is associated with advanced liver disease and a proinflammatory intestinal and systemic state

BACKGROUND AND AIMS

Protein-losing enteropathy (PLE) after Fontan surgery carries significant morbimortality. Its pathophysiology and association with other Fontan complications are poorly understood. Our aims were to examine whether Fontan-PLE is associated with greater liver damage and to assess the presence of systemic and intestinal inflammation.

METHODS

Fontan patients with PLE and Fontan controls without PLE matched for age and Fontan surgery procedure were included. Data were prospectively compiled on blood and stool tests, liver imaging, elastography, cardiac-MRI and cardiac catheterization.

RESULTS

Twenty-nine Fontan patients were enrolled (14 with PLE and 15 controls without PLE). Patients with PLE had more advanced liver disease estimated by non-invasive methods: blunt liver margins on ultrasonography (71.4% vs 26.7%, P = .027), greater median liver stiffness (25.4 vs 14.5 kPa, P = .003) and higher FIB-4 (P = .016). Portal hypertension-related signs were more common in patients with PLE including ascites (P = .035), larger spleen size (P = .005), oesophageal varices/splanchnic collateral shunts (P = .03), higher liver stiffness-spleen size-to-platelet ratio risk score (P < .001) and lower platelet count (P = .01). Systemic proinflammatory cytokines (TNF-α, interleukin-6), biomarkers of intestinal permeability (intestinal fatty-acid binding protein) and faecal calprotectin concentrations were also significantly increased in Fontan-PLE (P < .05). Faecal calprotectin directly correlated with alpha-1 antitrypsin clearance and inversely with cardiac index, total serum proteins and body mass index.

CONCLUSION

Fontan-PLE is associated with advanced liver disease and increased markers of systemic inflammation and intestinal permeability. Faecal calprotectin is elevated and correlates with Fontan-PLE severity. Liver assessment is mandatory in all Fontan patients, and especially in those with PLE.

Thoracoscopic cryoanalgesia: A new strategy for postoperative pain control in minimally invasive pectus excavatum repair

OBJECTIVE

Recent publications report early discharge and low opioid requirements after minimally invasive pectus excavatum repair treated with bilateral intercostal nerve cryoablation. Our aim is to report our initial experience with this technique.

MATERIAL AND METHODS

Retrospective analysis of medical records of patients undergoing bilateral thoracoscopic cryoanalgesia during minimally invasive pectus excavatum repair within our institution from September 2018 to March 2019.

TECHNIQUE

A cryoprobe was applied at -70 ºC for 2 minutes each from the 3rd to the 7th intercostal nerves bilaterally under thoracoscopic control. Postoperative pain was assessed using a visual analogue scale (VAS).

RESULTS

Twenty-one patients were included. Ninety percent were male, the mean age being 15.2 ± 4.29 years, and the mean weight being 53.6 ± 15.33 kg. The average Haller index was 5.1 ± 2.97, and the mean repair index was 37.6 ± 13.77%. The mean number of implants introduced was 2.55 ± 0.74. The mean duration of cryoanalgesia was 39.9 ± 21.1. No patients received epidural anesthesia. Mean postoperative stay was 1.64 ± 0.73 days. Seventy-one percent of the patients required 1 dose of opioids at the most for postoperative pain control. According to the VAS, the average pain score on postoperative days 1, 3, 7, and 21 was 2.55, 2.01, 0.5, and 0.06, respectively.

CONCLUSIONS

Bilateral thoracoscopic cryoanalgesia during minimally invasive pectus excavatum repair leads to early discharge and good postoperative pain control in all cases. Cryoanalgesia has become our treatment of choice for pain control in the thoracoscopic repair of pectus excavatum.

[Analysis of causes and factors associated with hospital readmission in mild and moderate polythraumatism: An observational study]

BACKGROUND

Early readmissions (ER) occur during the 30 days after discharge, ER are common and expensive, associated with a decrease in the quality of care. The rate of ER in polytraumatic patients (PTP) is estimated between 4.3-15%. Our objective was to identify those factors associated with ER and its characteristics after suffering mild-moderate trauma in our area.

MATERIAL AND METHOD

This is a retrospective observational study, including data of patients with (PTP) mild or moderate admitted between July 2012 and June 2017 in our institution and their ER in public hospitals and/or outpatient centers. Demographic variables, diagnoses, procedures and characteristics of readmissions were collected. After a bivariant analysis was done, a Logistic regression had benn performed to determine risk factors for ER.

RESULTS

1013 patients were included, with median age of 38 years, ISS of 3 points and initial hospital stay of 1 day. 185 patients were readmitted (18.3%). Independent factors associated with ER were: injury mechanism, especially bicycle accident (OR 2.26), comorbidities highlighting HBP (OR 1.83) and COPD (OR 1.98), fracture immobilization (OR 1.99) and hospital admission in the initial care (OR 0.56). The causes of ER were: pain 61.6%, wound infection 15.1%, scheduled cures and deferred interventions 12.97%, medical 6.4% and psychiatric decompensation. 2.7% CONCLUSION: The ERs in mild-moderate PTP are multifactorial, our results show an association between factors such as injury mechanism, the presence of comorbidities and the procedures performed in the sentinel episode and the rate of ER. The implementation of simple interventions at discharge could reduce its incidence clearly.

Occurrence of and radioanalytical methods used to determine medical radionuclides in environmental and biological samples. A review

Medical radionuclides are widely used in nuclear medicine practices today. Their production, handling and administration have different impacts on the environment and society due to the radioactive waste generated. Over recent years authors have taken an interest in the monitoring and safe disposal of this radiopharmaceutical waste, mainly in environmental and biological samples, and consequently a variety of radioanalytical methods for these matrices have been developed. The present review aims to outline the state of the art and the latest trends reported in the literature from 2007 to the present, focusing on the occurrence and determination of medical radionuclides in environmental and biological samples. Special attention is given to critically discussing the strengths and weaknesses of the different steps involved in determining medical radionuclides in these types of matrices. The methodologies presented are accompanied by examples.

Nuclear medicine: workplace monitoring and internal occupational exposure during a ventilation/perfusion single-photon emission tomography

The administration of ^99mTc-HDP to diagnose pulmonary thromboembolisms leads to the presence of ^99mTc in the environment of a nuclear medicine department, which could pose a potential risk of internal contamination to medical staff. Therefore, air samples from the administration room, gamma camera room and corridor of such a department were taken for the purpose of performing a workplace monitoring program of the medical centre under study, with maximum activity values of 640 ± 30 kBq/m³, 1.5 ± 0.1 kBq/m³ and 54 ± 3 kBq/m³, respectively, being obtained. These results correspond to committed effective doses received by exposed employees, via inhalation, when one ventilation/perfusion single-photon emission tomography study was performed, of 0.7 μSv, 0.004 μSv and 0.2 μSv, respectively. As inhalation is the employees' main exposure pathway to radio-aerosols, the internal dose of the nuclear medicine department's medical staff was also evaluated via urine bioassay measurements. Nuclear medicine nurses showed the highest ^99mTc activity in 24-h urine samples (2100 ± 130 Bq/day), resulting in a committed effective dose of 21 μSv for each diagnostic study performed. Even so, the performance of ventilation/perfusion diagnostic studies did not constitute a substantial radiological risk since the annual dose limit for exposed employees was not exceeded.

Presence of artificial radionuclides in samples from potable water and wastewater treatment plants

Human activity, such as the operation of nuclear power plants (NPPs) and the use of radionuclides in nuclear medicine, results in the presence of artificial radionuclides in surface waters, which may even reach potable water treatment plants (PWTPs) and wastewater treatment plants (WWTPs). In this study, water and sludge samples from a PWTP are radiologically monitored. The incoming water of the plant is influenced by the presence of an NPP upstream. Two WWTPs receiving wastewater from medical centres and other origins are also studied. As a result, ¹³¹I, ⁶⁰Co and ¹³⁷Cs have been determined in the dewatered sludge samples from the PWTP, while ¹³¹I, ^99mTc, ⁶⁷Ga and ¹¹¹In were detected in the sludge samples from the WWTPs. The radionuclide activities in the influent water from the WWTPs studied were lower than the minimum detectable activity values. Therefore, on the basis of our results, the analysis of sludge samples is very useful as it enables the concentration of any radionuclides that may be present in the incoming water. Lastly, as higher activity of ¹³¹I was detected in the samples studied, the total effective dose was assessed for WWTP workers, as they handle dewatered sludge containing this radionuclide. It can be concluded that there is no risk in terms of total exposure.

Versatile organoaluminium catalysts based on heteroscorpionate ligands for the preparation of polyesters

A series of alkyl aluminium complexes based on heteroscorpionate ligands were designed as catalysts for the ring-opening polymerisation of cyclic esters and ring-opening copolymerisation of epoxides and anhydrides. Treatment of AlX3 (X = Me, Et) with ligands bpzbeH [bpzbe = 1,1-bis(3,5-dimethylpyrazol-1-yl)-3,3-dimethyl-2-butoxide], bpzteH [bpzte = 2,2-bis(3,5-dimethylpyrazol-1-yl)-1-para-tolylethoxide], and (R,R)-bpzmmH [(R,R)-bpzmm = (1R)-1-{(1R)-6,6-dimethyl-bicyclo[3.1.1]-2-hepten-2-yl}-2,2-bis(3,5-dimethylpyrazol-1-yl)ethoxide] for 2 hours at 0 °C afforded the mononuclear dialkyl aluminium complexes [AlMe2{κ2-bpzbe}] (1), [AlEt2{κ2-bpzbe}] (2), [AlMe2{κ2-(R,R)-bpzmm}] (3) and [AlEt2{κ2-(R,R)-bpzmm}] (4), and the dinuclear dialkyl complexes [AlMe2{κ2-bpzte}]2 (5) and [AlEt2{κ2-bpzte}]2 (6). The molecular structures of the new complexes were determined by spectroscopic methods and confirmed by X-ray crystallography. The alkyl-containing aluminium complexes can act as highly efficient single-component initiators for the ring-opening polymerisation of ε-caprolactone and l-lactide and for the ring-opening copolymerisation of cyclohexene oxide and phthalic anhydride to give a range of biodegradable polyesters.

Colour change in a structural ornament is related to individual quality, parasites and mating patterns in the blue tit

Carry-over effects refer to processes that occur in one season and influence fitness in the following. In birds, two costly activities, namely reproduction and moult, are restricted to a small time window, and sometimes overlap. Thus, colour in newly moulted feathers is likely to be affected by the costs of reproduction. Using models of bird vision we investigated male colour change in a free-living population of blue tits (Cyanistes caeruleus) in three sampling occasions: spring 1, winter and spring 2. We related crown, tail, breast and cheek feather colouration after the moult (winter) to the intensity of infections by blood parasites during reproduction (spring 1). In the following spring (spring 2), we explored mating patterns with respect to changes in feather colour (springs 1 vs. 2). Males that were less intensely infected by the malaria parasite Plasmodium while breeding showed purer white cheek feathers in winter, which may indicate higher feather quality. Increased brightness in the white cheek was associated with better body condition during reproduction. In the following season, males with brighter cheeks paired with females that had noticeably brighter cheek patches compared to the male's previous mate. These results suggest that the conditions experienced during reproduction are likely to affect moult and thus feather colouration, at least in the white patch. High quality individuals may allocate resources efficiently during reproduction increasing future reproductive success through variation in mating patterns. Carry-over effects from reproduction might extend not only to the non-breeding phase, but also to the following breeding season.

Transmission and immunopathology of the avian influenza virus A/Anhui/1/2013 (H7N9) human isolate in three commonly commercialized avian species

H7N9 virus infection is a global concern, given that it can cause severe infection and mortality in humans. However, the understanding of H7N9 epidemiology, animal reservoir species and zoonotic risk remains limited. This work evaluates the pathogenicity, transmissibility and local innate immune response of three avian species harbouring different respiratory distribution of α2,6 and α2,3 SA receptors. Muscovy ducks, European quails and SPF chickens were intranasally inoculated with 10⁵ embryo infectious dose (EID)₅₀ of the human H7N9 (A/Anhui/1/2013) influenza isolate. None of the avian species showed clinical signs or macroscopic lesions, and only mild microscopic lesions were observed in the upper respiratory tract of quail and chickens. Quail presented more severe histopathologic lesions and avian influenza virus (AIV) positivity by immunohistochemistry (IHC), which correlated with higher IL-6 responses. In contrast, Muscovy ducks were resistant to disease and presented higher IFNα and TLR7 response. In all species, viral shedding was higher in the respiratory than in the digestive tract. Higher viral shedding was observed in quail, followed by chicken and ducks, which presented similar viral titres. Efficient transmission was observed in all contact quail and half of the Muscovy ducks, while no transmission was observed between chicken. All avian species showed viral shedding in drinking water throughout infection.

The major Alternaria alternata allergen, Alt a 1: A reliable and specific marker of fungal contamination in citrus fruits

The ubiquitously present spores of Alternaria alternata can spoil a wide variety of foodstuffs, including a variety of fruits belonging to the Citrus genus. The major allergenic protein of A. alternata, Alt a 1, is a species-specific molecular marker that has been strongly associated with allergenicity and phytopathogenicity of this fungal species. This study aimed to evaluate the potential of the detection of Alt a 1 as a reliable indicator of A. alternata contamination in citrus fruits. To accomplish this aim, sixty oranges were artificially infected with a spore suspension of A. alternata. Internal fruit material was collected at different incubation times (one, two and three weeks after the fungal inoculation) and used for both total RNA extraction and protein extraction. Alt a 1 detection was then performed by polymerase chain reaction (PCR) amplification using Alt a 1 specific primers and by enzyme-linked immunosorbent assay (ELISA). The experimental model presented in this work was effective to simulate the typical Alternaria black rot phenotype and its progression. Although both PCR and ELISA techniques have been successfully carried out for detecting Alt a 1 allergen in A. alternata infected oranges, the PCR method was found to be more sensitive than ELISA. Nevertheless, ELISA results were highly valuable to demonstrate that considerable amounts of Alt a 1 are produced during A. alternata fruit infection process, corroborating the recently proposed hypothesis that this protein plays a role in the pathogenicity and virulence of Alternaria species. Such evidence suggests that the detection of Alt a 1 by PCR-based assay may be used as a specific indicator of the presence of pathogenic and allergenic fungal species, A. alternata, in fruits. This knowledge can be employed to control the fungal infection and mitigate agricultural losses as well as human exposure to A. alternata allergens and toxins.

Consensus guidelines for diagnosis, treatment and follow-up of patients with pancreatic cancer in Spain

The management of patients with pancreatic cancer has advanced over the last few years. We convey a multidisciplinary group of experts in an attempt to stablish practical guidelines for the diagnoses, staging and management of these patients. This paper summarizes the main conclusions of the working group. Patients with suspected pancreatic ductal adenocarcinoma should be rapidly evaluated and referred to high-volume centers. Multidisciplinary supervision is critical for proper diagnoses, staging and to frame a treatment plan. Surgical resection together with chemotherapy offers the highest chance for cure in early stage disease. Patients with advanced disease should be classified in treatment groups to guide systemic treatment. New chemotherapeutic regimens have resulted in improved survival. Symptomatic management is critical in this disease. Enrollment in a clinical trial is, in general, recommended.

Sublingual tacrolimus administration provides similar drug exposure to per-oral route employing lower doses in liver transplantation: a pilot study

BACKGROUND

Per-oral tacrolimus administration is not always practicable. Sublingual administration is a potential alternative, but its feasibility and effectiveness compared with oral route has not been established.

AIM

To compare tacrolimus drug exposure after sublingual and oral administration in liver transplant recipients.

METHODS

Experimental, open-label, non-randomised, cross-over study. Tacrolimus exposure was evaluated in 32 liver transplant recipients receiving oral administration. 12 h tacrolimus area-under-the-curve (AUC_{0-12 h} ) was calculated using tacrolimus blood concentrations at 0-0.5-1-2-4-6-8-12 hrs post-dose. Recipients were switched to sublingual administration, and dose was adjusted to reach similar trough levels, new AUC_{0-12 h} was calculated. Correlation between AUC_{0-12 h} and trough levels was determined for both oral and sublingual phases.

RESULTS

Similar trough levels were accomplished with oral and sublingual administration (6.68 ± 2 ng/mL vs. 6.62 ± 1.9 ng/mL (P = 0.8)). Although concentration 2 h post dose was higher in oral phase (15.36 ± 7.14 vs. 13.18 ± 5.64, P = 0.015), AUC_{0-12 h} was similar in both phases (116.6 ± 34.6 vs. 111.5 ± 36.93 ng/mL_* h, P = 0.19). Daily dose of tacrolimus required in sublingual phase was 37% lower than that used in oral phase (P < 0.0001), suggesting significantly increased bioavailability of tacrolimus when employing sublingual route. Good correlation between AUC_{0-12 h} and trough levels was observed in sublingual phase (r² = 0.74). Twenty-two recipients were maintained on sublingual administration after the end of study (mean follow-up: 18.7 ± 5.8 months). No difference in liver function tests or rejection rates was found during follow-up period.

CONCLUSIONS

Sublingual administration of tacrolimus is feasible and provides similar drug exposure compared with oral administration. In our study, at long-term follow-up, sublingual administration was not associated with liver transplant rejection.

Differential uPA Expression by TGF-β1 in Gingival Fibroblasts

Transforming Growth Factor-β1 (TGF-β1) plays a key role in connective tissue remodeling and inflammation. Under pathological conditions, like periodontal disease, fibroblasts may display an altered response to this growth factor. To investigate this question, we have studied whether TGF-β1 may differentially regulate the expression of urokinase at the protein level in primary cultures of fibroblasts derived from healthy gingiva, granulation tissue from gingival wounds, and chronic periodontal disease. We observed that TGF-β1 may repress urokinase expression in healthy gingival fibroblasts and promote its production in granulation-tissue fibroblasts. A significant correlation was found between expression of the myofibroblast marker α-smooth-muscle actin and stimulation of urokinase production by TGF-β1. Immunostaining of gingival wounds showed that myofibroblasts were involved in urokinase production. TGF-β1-stimulated urokinase expression was blocked after inhibition of the c-jun-NH2 terminal kinase signaling pathway. We propose that stimulation of urokinase production by TGF-β1 is involved in the responses of activated fibroblasts to tissue injury.

Changes in Volatile Compounds during Ripening in Grapes of Airén, Macabeo and Chardonnay White Varieties Grown in La Mancha Region (Spain)

Changes in volatile compounds in musts and skins of grapes of Airén, Macabeo and Chardonnay white varieties were determined during ripening. The musts of the Airén variety contained higher concentrations of c-3-hexenol; musts of the Macabeo variety were the richest in t-3-hexenol and 2,4-hexadienal, while the Chardonnay musts stood out for having higher concentrations of benzaldehyde, phenylacetaldehyde and benzyl alcohol. The skins of the three varieties were both qualitatively and quantitatively richer in volatiles than were the musts. The skins of the Airén grapes had the highest levels of nerol. Airén grapes were the only variety in which citronellol was present in the skins. Low concentrations of eugenol were detected in the skins of the Chardonnay grape variety but were not present in the other two varieties. Changes in the concentration of the volatile compounds during ripening were not uniform; this made difficult the determination of the optimum level of ripening for each variety on the basis of the volatile compound content. Nevertheless, results indicated that C6 compounds and terpene concentrations reached a maximum at 6-8 ° Baumé in the Airén grapes and at around 11 ° Baumé in the Chardonnay and Macabeo grapes.

Coronavirus Infection in Ferrets: Antigen Distribution and Inflammatory Response

Multisystemic granulomatous lesions are the most common finding in ferrets infected by ferret systemic coronavirus (FRSCV). To characterize the inflammatory response developed against this virus, lesions from 4 naturally infected ferrets were examined. Lesions were classified into the 4 known types of granulomas (granulomas without necrosis [G], granulomas with necrosis [G-N], granulomas with neutrophils [G-NL], and diffuse granulomatous inflammation [DG]). The cellular composition of the lesions was characterized on the basis of cellular morphology and immunohistochemistry using markers for T and B-lymphocytes, plasma cells, macrophages, and neutrophils. The extent and distribution of viral antigen expression was also assessed. In G lesions, macrophages were mainly located in the center of the granuloma, with a moderate number of T-lymphocytes scattered among the macrophages, plasma cells, and B-lymphocytes. G-N lesions exhibited a necrotic center surrounded by abundant macrophages, some T-lymphocytes, plasma cells, and a few B-lymphocytes. In G-NL lesions, there was a central area dominated by neutrophils with low numbers of macrophages, plasma cells, and lymphocytes. DG presented similar cell proportions, but distributed evenly throughout the lesions. FRSCV was expressed in G, G-NL, G-N, and DG, with decreasing numbers of immunoreactive cells. This study reveals the important role of macrophages in the inflammatory response of ferrets against the virus and the variable proportions of leukocytes among different types of lesions, indicating their variable age. The results also confirm the similarities of the disease in ferrets to feline infectious peritonitis.