Ultra-sensitive, rapid detection of dried bloodstains by surface enhanced Raman scattering on Ag substrates

A simple water extraction and transfer procedure is found to result in reproducible and highly sensitive 785 nm excited SERS spectra of 24 h dried bloodstains on Ag nanoparticle substrates. This protocol allows confirmatory detection and identification of dried stains of blood that have been diluted by up to 10⁵ in water on Ag substrates. While previous SERS results demonstrated similar performance on Au substrates when a 50% acetic acid extraction and transfer procedure was used, the water/Ag methodology avoids any potential DNA damage when the sample size is extremely small (≤∼1 μL) due to low pH exposure. The water only procedure is not effective on Au SERS substrates. This metal substrate difference results from the efficient red blood cell lysis and hemoglobin denaturation effects of the Ag nanoparticle surfaces as compare to that of Au nanoparticles. Consequently, the 50% acetic acid exposure is required for the acquisition of 785 nm SERS spectra of dried bloodstains on Au substrates.

A Systematic Review of the Factors Associated with Post-Traumatic Growth in Parents Following Admission of Their Child to the Intensive Care Unit

This systematic review aims to identify the demographic, clinical and psychological factors associated with post-traumatic growth (PTG) in parents following their child's admission to the intensive care unit (ICU). Papers published up to September 2021 were identified following a search of electronic databases (PubMed, Medline, Web of Science, PsycINFO, CINAHL, PTSDpubs and EMBASE). Studies were included if they involved a sample of parents whose children were previously admitted to ICU and reported correlational data. 1777 papers were reviewed. Fourteen studies were eligible for inclusion; four were deemed to be of good methodological quality, two were poor, and the remaining eight studies were fair. Factors associated with PTG were identified. Mothers, and parents of older children, experienced greater PTG. Parents who perceived their child's illness as more severe had greater PTG. Strong associations were uncovered between PTG and post-traumatic stress, psychological well-being and coping. PTG is commonly experienced by this population. Psychological factors are more commonly associated with PTG in comparison with demographic and clinical factors, suggesting that parents' subjective ICU experience may be greater associated with PTG than the objective reality.

Surface enhanced Raman scattering specificity for detection and identification of dried bloodstains

Surface enhanced Raman spectroscopy (SERS) provides highly specific vibrational signatures identifying dried blood for a variety of forensic applications. SERS spectra on Au nanoparticle substrates excited at 785 nm are found to identify dried stains of human and nonhuman blood from seven animals, and distinguish stains due to menstrual and peripheral blood. In addition, the unique SERS bloodstain spectrum is distinct from the SERS spectra of thirty red-brown stains of potential household substances that could be visually mistaken for bloodstains and from food stains that have been shown to give positive results with presumptive colorimetric blood tests. Finally, a SERS swab procedure has been developed and demonstrates that the substrates that a blood sample dried on does not offer any Raman or fluorescence interference for the SERS identification of dried blood. Such bloodstains on porous and nonporous materials are all identical and exclusively due to the heme moiety of hemoglobin. Optimized selection of the extraction solvent is found to control the chemical composition of molecular components appearing in the SERS spectrum of complex, multicomponent biological mixtures, such as body fluids.

Factors influencing antimicrobial prescription attitudes in bloodstream infections: susceptibility results and beyond. An exploratory survey

BACKGROUND

Novel rapid antimicrobial susceptibility testing (RAST) methods promise quicker de-escalation of broad-spectrum antibiotics. However, other behavioural and situational factors influencing antimicrobial prescription are not well known.

AIM

To explore factors associated with optimal antimicrobial prescription in patients with Gram-negative bloodstream infection and to propose specific scenarios in which a rapid antimicrobial susceptibility result may help to optimize prescribing.

METHODS

Exploratory survey (April-August 2018) in the UK and Spain using clinical case-related questions. Seniority, specialty and country of practice were recorded. Cases described patients with Gram-negative bloodstream infections, their empirical treatment and clinical course and the hypothetical RAST result. Respondents chose one of several options regarding antibiotic treatment management. Microbiologically optimal antibiotic choice (MOAC) was agreed by expert consensus beforehand. Responses were categorized as MOAC, request for support or sub-optimal choice. The relationship between the RAST result and the clinical course was defined as concordant (susceptible organism-clinical improvement; resistant organism-clinical deterioration) or as discordant otherwise.

FINDINGS

A total of 426 respondents (UK: 332; Spain: 94) and 1494 answers were analysed. Multivariate analysis identified that requests for support were 87% less likely in Spain; that antimicrobial resistance and clinical deterioration were associated with both increased request for support (odds ratio (OR) 7.66 and OR 4.26, respectively) and MOAC (OR 2.08 and OR 2.06, respectively). A discordant clinical course was associated with 82% lower odds for MOAC. Out-of-hours results, seniority and specialty did not have an effect.

CONCLUSION

Antimicrobial choice is influenced by each country's type of practice, clinical course and susceptibility results. Antimicrobial resistance was associated with increased optimal treatment, suggesting RAST may be less useful for step-down decisions in settings with low baseline resistance rates.

[Design of a thromboprophylaxis care process in patients with atrial fibrillation]

OBJECTIVE

To describe the milestones in the anticoagulant care process of atrial fibrillation patients (AF), as well as quality and safety indicators, in order to establish an integrated care process of these patients in the Community of Madrid.

METHODS

A consensus conference technique was applied, with the participation of 21 professionals (seven in the Steering Group and 14 known experts), from the specialties of Emergency, Internal Medicine, Cardiology, Neurology, Haematology, Family Medicine, Nursing, and Quality. Hospitals and Primary Care were represented. Milestones, elements and barriers/limitations were agreed upon in the care process of anticoagulated AF patients. A minimum set of indicators were also defined to assess the quality of care.

RESULTS

Four milestones (stratification of thromboembolism and bleeding risk, evaluation for anticoagulant treatment, follow-up of direct-acting oral anticoagulants, and follow-up of treatment with vitamin K antagonists) were identified. A total of 14 barriers/limitations were also prioritised. In total, six indicators were defined (two structural-related, two processes-related, and two outcomes-related).

CONCLUSIONS

Milestones and critical activities, together with a set of indicators, have been agreed for the development of guidelines with which to achieve a better therapeutic approach for anticoagulated AF patients.

c-erbB-2 Oncoprotein Content in Gastric Cancer and in Adjacent Mucosa

The aim of this study was to evaluate, by means of an immunoenzymatic assay, the membranous and cytosolic c-erbB-2 oncoprotein contents in primary tumors and in adjacent mucosa from gastric cancer patients. Fifty-two patients with primary gastric adenocarcinomas were enrolled in this prospective study. c-erbB-2 protein levels were significantly higher in membranous than in cytosolic samples, both in neoplastic tissues (median: 3602 vs 525 NHU/mg protein; p<0.0001) and in adjacent mucosa samples (median: 3174 vs 509 NHU/mg protein; p<0.0001). Nevertheless, there was a significant positive relation between membranous and cytosolic c-erbB-2 protein contents in both neoplastic tissue (p<0.001) and adjacent mucosa (p<0.001) samples. There was no significant difference in the membranous c-erbB-2 protein content between neoplastic tissues and adjacent mucosa samples. However, the cytosolic c-erbB-2 content was significantly higher in neoplastic tissues than in adjacent mucosa (p<0.05). Finally, the results did not show any significant correlations of these oncoprotein contents with patient characteristics, clinicopathologic parameters and overall survival of the study population.

Some physical and thermal characteristics of amaranth starch Algunas propiedades físicas y térmicas del almidón de amaranto

Starch was isolated from Amaranthus cruentus to study some physicochemical properties (swelling power, solubility, water absorption and sorption equilibria) and compared with corn starch. Swelling power and water absorption capacity were higher for amaranth than for corn starch, whereas the solubility of amaranth starch was, in comparison, lower. The adsorption capacity at monolayer value of both starches was practically coincident. However, the sorbed water at monolayer seemed to be more firmly adsorbed in corn than in amaranth starch. The specific surface area of adsorption for both materials was above 300 m2/g. Gelatinization temperatures of amaranth starch measured by differential scanning calorimetry varied with the water/starch ratio and the heating rate. For water/ starch ratios higher than 2:1, the peak temperature was practically constant and equal to 68.3 °C. The enthalpy of gelatinization reached a maximum of 11.5-11.7 J/g. Two activation energies were found with a distinct break point at 69.2 °C, where rapid gelatinization of amaranth starch begins.

[What were the obstacles to the development of outpatient cataract surgery in Toulouse University Hospital in 2013?]

INTRODUCTION

Cataract surgery is an ideal candidate for outpatient care. In 2013, in the Toulouse University Hospital, outpatient care rate for phacoemulsification was 75.8%. We conducted this study to identify the barriers that limit the development of outpatient cataract surgery in our establishment.

MATERIAL AND METHODS

A retrospective observational study was conducted. We included all patients who underwent phacoemulsification (Medical Act Code BFGA004) as a traditional inpatient in 2013. We excluded admissions for which the medical, anesthesia or nursing records, as well as scheduling sheets, were incomplete. Patients were classified according to the reason for inpatient hospitalization and the type of surgery: cataract as primary surgery or cataract as combined procedure.

RESULTS

Two hundred and ninety-eight stays were included with a mean age of 66.8 ± 16.8 years, and a male/female ratio of 0.76. The indication for inpatient hospitalization was a social, surgical or anesthetic reason in the following respective proportions: 41, 34 and 8% of cases. Failure of ambulatory care represented 7% of cases. Social isolation represented 89% of social reasons. In a combined gesture, the reason was surgical in 89% of cases.

CONCLUSION

Development of outpatient surgery requires the participation of all involved. Taking into account the social factors is an essential element for developing ambulatory surgery. Social isolation is a frequent situation requiring a societal response. With regard to surgical considerations, practice patterns must target outpatient combined procedures in particular.

Modification over time of pulse wave velocity parallel to changes in aortic BP, as well as in 24-h ambulatory brachial BP

Arterial stiffness as assessed by carotid-femoral pulse wave velocity (cfPWV) is a marker of preclinical organ damage and a predictor of cardiovascular outcomes, independently of blood pressure (BP). However, limited evidence exists on the association between long-term variation (Δ) on aortic BP (aoBP) and ΔcfPWV. We aimed to evaluate the relationship of ΔBP with ΔcfPWV over time, as assessed by office and 24-h ambulatory peripheral BP, and aoBP. AoBP and cfPWV were evaluated in 209 hypertensive patients with either diabetes or metabolic syndrome by applanation tonometry (Sphygmocor) at baseline(b) and at 12 months of follow-up(fu). Peripheral BP was also determined by using validated oscillometric devices (office(o)-BP) and on an outpatient basis by using a validated (Spacelabs-90207) device (24-h ambulatory BP). ΔcfPWV over time was calculated as follows: ΔcfPWV=[(cfPWVfu-cfPWVb)/cfPWVb] × 100. ΔBP over time resulted from the same formula applied to BP values obtained with the three different measurement techniques. Correlations (Spearman 'Rho') between ΔBP and ΔcfPWV were calculated. Mean age was 62 years, 39% were female and 80% had type 2 diabetes. Baseline office brachial BP (mm Hg) was 143±20/82±12. Follow-up (12 months later) office brachial BP (mm Hg) was 136±20/79±12. ΔcfPWV correlated with ΔoSBP (Rho=0.212; P=0.002), Δ24-h SBP (Rho=0.254; P<0.001), Δdaytime SBP (Rho=0.232; P=0.001), Δnighttime SBP (Rho=0.320; P<0.001) and ΔaoSBP (Rho=0.320; P<0.001). A multiple linear regression analysis included the following independent variables: ΔoSBP, Δ24-h SBP, Δdaytime SBP, Δnighttime SBP and ΔaoSBP. ΔcfPWV was independently associated with Δ24-h SBP (β-coefficient=0.195; P=0.012) and ΔaoSBP (β-coefficient= 0.185; P=0.018). We conclude that changes in both 24-h SBP and aoSBP more accurately reflect changes in arterial stiffness than do office BP measurements.

GAL3ST2 from mammary gland epithelial cells affects differentiation of 3T3-L1 preadipocytes

INTRODUCTION

In the mammary gland, the involution that occurs when lactation ends is an important period for cancer development. We have previously demonstrated stromal-epithelium interactions evaluating conditioned medium of adipose tissue on breast epithelial metalloproteases activity (Creydt et al., Clin Transl Oncol 15:124-131, 2013). Here, we evaluated the effects of conditioned medium of breast epithelial mammary cells on stromal cells.

MATERIALS AND METHODS

Conditioned medium from normal murine mammary gland cell line (NMuMG) and conditioned medium proteins were obtained. Then, they were evaluated on modulation of adipocyte differentiation, using 3T3-L1 cell line.

RESULTS

We described, for the first time, that breast epithelial mammary cells could produce the enzyme galactose 3-O-sulfotransferase 2 (GAL3ST2). Importantly, GAL3ST2 is present in NMMuMG and two human breast cancer cell lines, and it is more strongly expressed in more metastatic tumors. When 3T3-L1 preadipocyte differentiation was triggered in the presence of conditioned medium from NMuMG or GAL3ST2, triglyceride accumulation was decreased by 40 % and C/EBPβ expression by 80 % in adipocytes. In addition, the expression of FABP4 (aP2), another marker of adipocyte differentiation, was inhibited by 40 % in GAL3ST2-treated cells.

CONCLUSIONS

Taken together, these results suggest that GAL3ST2 would interfere with normal differentiation of 3T3-L1 preadipocytes; raising the possibility that it may affect normal differentiation of stromal preadipocytes and be a link to tumor metastatic capacity.

[Multimodal imaging in the diagnosis of acute macular neuroretinopathy]

INTRODUCTION

Acute macular neuroretinopathy is a retinal disease, usually presenting with a "normal fundus". Thus, this condition can be mistaken for optic neuropathy. Herein we present five clinical cases of patients affected with acute macular neuroretinopathy; one of them is a retrospective diagnosis while the others were diagnosed on initial examination. In the five cases, multimodal imaging with infrared photography and OCT helped to establish the diagnosis.

MATERIAL AND METHODS

Retrospective study of five clinical cases. Initial and final best visual acuities as well as infrared and OCT imaging were collected for all patients.

RESULTS

All patients initially reported a visual disturbance associated with a more or less severe decrease in visual acuity. Infrared imaging showed a dark, perifoveolar appearance of the lesions. In all cases, OCT images showed thickening and hyperreflectivity of the outer plexiform layer, extending towards the outer retinal layers.

CONCLUSION

Acute macular neuroretinopathy is a clinical entity that has been long-described, which now benefits widely from new imaging technologies, allowing an earlier and more accurate diagnosis, but calling into question the actual name of this condition. The exact pathophysiology of the condition remains nonetheless incompletely elucidated.

Efficacy and safety of fosfomycin plus imipenem as rescue therapy for complicated bacteremia and endocarditis due to methicillin-resistant Staphylococcus aureus: a multicenter clinical trial

BACKGROUND

There is an urgent need for alternative rescue therapies in invasive infections caused by methicillin-resistant Staphylococcus aureus (MRSA). We assessed the clinical efficacy and safety of the combination of fosfomycin and imipenem as rescue therapy for MRSA infective endocarditis and complicated bacteremia.

METHODS

The trial was conducted between 2001 and 2010 in 3 Spanish hospitals. Adult patients with complicated MRSA bacteremia or endocarditis requiring rescue therapy were eligible for the study. Treatment with fosfomycin (2 g/6 hours IV) plus imipenem (1 g/6 hours IV) was started and monitored. The primary efficacy endpoints were percentage of sterile blood cultures at 72 hours and clinical success rate assessed at the test-of-cure visit (45 days after the end of therapy).

RESULTS

The combination was administered in 12 patients with endocarditis, 2 with vascular graft infection, and 2 with complicated bacteremia. Therapy had previously failed with vancomycin in 9 patients, daptomycin in 2, and sequential antibiotics in 5. Blood cultures were negative 72 hours after the first dose of the combination in all cases. The success rate was 69%, and only 1 of 5 deaths was related to the MRSA infection. Although the combination was safe in most patients (94%), a patient with liver cirrhosis died of multiorgan failure secondary to sodium overload. There were no episodes of breakthrough bacteremia or relapse.

CONCLUSIONS

Fosfomycin plus imipenem was an effective and safe combination when used as rescue therapy for complicated MRSA bloodstream infections and deserves further clinical evaluation as initial therapy in these infections.

Cooperative role between p21cip1/waf1 and p27kip1 in premature senescence in glandular proliferative lesions in mice

Cellular senescence has been considered a novel target for cancer therapy. It has also been pointed out that p21(cip1/waf1) and p27(kip1) cyclin-dependent kinase inhibitors (CKIs) play a role in cellular senescence in some tumor types. Therefore, in order to address the possibility of a cooperative role between p21 and p27 proteins in senescence in vivo we analyzed cellular senescence in spontaneous glandular proliferative lesions (adrenal, thyroid and pituitary glands) in a double-KO mice model, using γH2AX, p53, p16, PTEN and Ki67 as senescence markers. The results obtained showed that p21p27 double-null mice had the lowest number of γH2AX positive cells in glandular hyperplasias and benign tumors. Also, in this group, Ki67 proliferation index correlated with a lower immunohistochemical expression of γH2AX and p53. The expression of p16 and PTEN do not seem to cause synergism of senescence in the benign lesions analyzed in p21p27 double-KO mice. These observations suggest an intrinsic cooperation between p21 and p27 CKIs in the activation of stress-induced cellular senescence and tumor progression in vivo, which would be a physiological mechanism to prevent tumor cell proliferation.

Gemcitabine/cisplatin in patients with advanced bladder and impaired renal function: A retrospective analysis

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Background: A four-weekly regimen of gemcitabine and cisplatin (GEMCIS) has similar activity and is less toxic than MVAC in advanced bladder cancer. However, full-dose cisplatin in unfit patients with impaired renal function is contraindicated and other carboplatin-based schedules have been developed. We have previously reported the feasibility of GEMCIS in a biweekly schedule in unfit patients with renal impairment. Here we report a multicenter retrospective study of this biweekly regimen in patients with impaired renal function.

Methods: Between January 2004 and October 2009, 40 patients with locally advanced nonsurgically resectable or metastatic bladder cancer and impaired renal function were included. Treatment consisted of gemcitabine 2500 mg/m2 on day 1 and cisplatin 35 mg/m2 on day 1, every 14 days.

Results: Median age of the patients was 73 years (range: 51-82 years). Median IK was 80% (range: 60-100%). Mean creatinine clearance was 49 ml/min (range:37-59 ml/min). Eight patients had previously received chemotherapy with gemcitabine and/or platinum based therapy. Metastatic localizations were: 17 lymph nodes, 10 pulmonary, 10 bone, 7 liver, 12 pelvic and 1 central nervous system. The median number of cycles/patient was 6 (1-13). Out of 36 patients evaluable for response, there was one complete response, 14 partial responses (ORR: 42%; 95% CI 27-58%), 11 stabilizations and 10 progressive diseases. Hematologic toxicities were grade 1 anaemia in 15 patients, grade 2 in 8; grade 3 in 2; grade 3 neutropenia in 5 patients and grade 4 in 1 patient; grade 3 plaquetopenia in 3 patients. Nonhematologic toxicities were grade 1-2 vomiting in 2 patients. Two patients showed a grade 2 hepatic toxicity. Worsening of the renal function was observed in two patients. Alopecia grade 1-2 was seen in three patients. There was one toxic death related to metabolic acidosis.The median progression-free survival is 15 weeks. The median OS from first cycle of GEMCIS is 35 weeks and 1-year OS is 43% (St error 9%).

Conclusions: A two-weekly schedule of gemcitabine plus cisplatin is feasible, active, and generally well tolerated in an outpatient setting in unfit patients with poor renal reserve.

No significant financial relationships to disclose.