Testing the trade-balance model: resource stoichiometry does not sufficiently explain AM effects

Variations in arbuscular mycorrhizae (AM) effects on plant growth (MGR) are commonly assumed to result from cost : benefit balances, with C as the cost and, most frequently, P as the benefit. The trade-balance model (TBM) adopts these assumptions and hypothesizes that mycorrhizal benefit depends on C : N : P stoichiometry. Although widely accepted, the TBM has not been experimentally tested. We isolated the parameters included in the TBM and tested these assumptions using it as framework. Oryza sativa plants were supplied with different N : P ratios at low light level, establishing different C : P and C : N exchange rates, and C, N or P limitation. MGR and effects on nutrient uptake, %M, ERM, photosynthesis and shoot starch were measured. C distribution to AM fungi played no role in MGR, and N was essential for all AM effects, including on P nutrition. C distribution to AM and MGR varied with the limiting nutrient (N or P), and evidence of extensive interplay between N and P was observed. The TBM was not confirmed. The results agreed with the exchange of surplus resources and source-sink regulation of resource distribution among plants and AMF. Rather than depending on exchange rates, resource exchange may simply obey both symbiont needs, not requiring further regulation.

Pulmonary valve replacement in tetralogy of Fallot - who and how?

BACKGROUND AND AIM

Pulmonary regurgitation is the most common complication in repaired tetralogy of Fallot patients. Severe chronic pulmonary regurgitation can be tolerated for decades, but if not treated, it can progress to symptomatic, irreversible right ventricular dilatation and dysfunction. We investigated clinical associations with pulmonary valve replacement among patients with significative pulmonary regurgitation and how interventional developments can change their management.

METHODS

All adult patients with repaired tetralogy of Fallot who were followed at an adult CHD Clinic at a single centre from 1980 to 2022 were included on their first outpatient visit. Follow-up was estimated from the time of correction surgery until one of the following events occurred first: pulmonary valve replacement, death, loss to follow-up or conclusion of the study.

RESULTS

We included 221 patients (116 males) with a median age of 19 (18-25). At a median age of 33 (10) years old, 114 (51%) patients presented significant pulmonary regurgitation. Among patients with significant pulmonary regurgitation, pulmonary valve replacement was associated with male gender, older age at surgical repair, and longer QRS duration in adulthood. Pulmonary valve replacement was performed in 50 patients, including four transcatheter pulmonary valve implantations, at a median age of 34 (14) years.

CONCLUSION

Pulmonary regurgitation affects a large percentage of tetralogy of Fallot adult patients, requiring a long-term clinical and imaging follow-up. Sex, age at surgical repair and longer QRS are associated with the need of PVR among patients with significative pulmonary regurgitation. Clinical practice and current literature support TPVI as the future gold standard intervention.

Plant ammonium sensitivity is associated with the external pH adaptation, repertoire of nitrogen transporters, and nitrogen requirement

Modern crops exhibit diverse sensitivities to ammonium as the primary nitrogen source, influenced by environmental factors such as external pH and nutrient availability. Despite its significance, there is currently no systematic classification of plant species based on their ammonium sensitivity. This study conducts a meta-analysis of 50 plant species and presents a new classification method based on the comparison of fresh biomass obtained under ammonium and nitrate nutrition. The classification uses the natural logarithm of biomass ratio as the size effect indicator of ammonium sensitivity. This numerical parameter is associated with critical factors for nitrogen demand and form preference, such as Ellenberg indicators and the repertoire of nitrogen transporters for ammonium and nitrate uptake. Finally, a comparative analysis of the developmental and metabolic responses, including hormonal balance, is conducted in two species with divergent ammonium sensitivity values in the classification. Results indicate that nitrate has a key counteracting role of ammonium toxicity in species with a higher abundance of genes encoding NRT2-type proteins and fewer of the AMT2-type proteins. Additionally, the study confirms the reliability of the phytohormone balance and methylglyoxal content as indicators for anticipating ammonium toxicity.

Hormetic Effect of Wood Distillate on Hydroponically Grown Lettuce

The addition of biostimulants to nutrient solutions of hydroponically grown crops to speed up plant growth and improve plant yield and quality has been attracting more and more attention. This study investigated the effects of wood distillate (WD) addition to hydroponically grown lettuce (Lactuca sativa L.) plants. Two concentrations of WD, 0.2% and 0.5%, were added to the nutrient solution, and biometric (i.e., leaf fresh weight, root fresh weight, root length and root surface area), photosynthetic (i.e., chlorophyll a, chlorophyll b, and carotenoid content) and biochemical (i.e., electrolyte leakage, total polyphenols, total flavonoids, and total antioxidant power content) parameters were evaluated. The effects of WD were hormetic, as the 0.2% concentration stimulated biometric and biochemical parameters, while the 0.5% concentration inhibited plant growth. Based on these results, it can be suggested that the addition of 0.2% WD to the nutrient solution has a stimulating effect on the growth of lettuce plants, and could be a successful strategy to boost the yield of crops grown hydroponically.

Polythylene glycol severe allergy and SARS-CoV-2 vaccines: usefulness of testing with PEG 1500 extract

Summary

Background. Polyethylene glycol (PEG) is being used for first time as an excipient for mRNA anti-SARS-CoV-2 vaccines containing PEG 2000, highlighting it as a potential cause of anaphylaxis. Methods. We evaluated 126 patients with moderate-high risk of allergy to SARS-CoV-2 vaccines referred to our department from March-December 2021. Skin tests were performed with PEG 1500 extract (Roxall), using a stepwise approach, with readings at 30 minutes: prick tests with 0.1%, 1% and 10% concentrations; if negative, intradermal tests with 0.0001%, 0.001% and 0.01% concentrations. The same protocol was applied to 5 healthy controls Results. Six patients had positive immediate intradermal tests with PEG 1500, all with severe PEG allergy: one with a near-fatal anaphylaxis after glucocorticoid injection containing PEG 3350 and five with systemic allergic reactions after mRNA vaccines containing PEG 2000 (Pfizer-BioNTech or Moderna). One patient developed anaphylaxis during intradermal test. These six patients were negative to polysorbate 80. The remaining 120 patients had negative tests to PEG 1500; seven had positive tests to polysorbate 80. All controls had negative tests. Conclusions. To our knowledge this is the first study describing the allergy work-up testing with PEG 1500 commercial extract in the scope of SARS-CoV-2 vaccination. The algorithm designed for skin tests revealed to be a useful tool. Severe PEG allergy was diagnosed in 5% of patients, contraindicating PEG-containing vaccines. PEG allergy was excluded in one hundred patients that afterwards took SARS-CoV-2 vaccines containing PEG 2000. Investigation should be conducted in specialized drug allergy centers..

Using Science and Technology to Unveil The Hidden Delicacy Terfezia arenaria, a Desert Truffle

Terfezia arenaria is a desert truffle native to the Mediterranean Basin region, highly appreciated for its nutritional and aromatic properties. Despite the increasing interest in this desert truffle, T. arenaria is not listed as an edible truffle authorized for trade in the European Union. Therefore, our objective was to showcase T. arenaria's nutritional and chemical composition and volatile profile. The nutritional analysis showed that T. arenaria is a good source of carbohydrates (67%), proteins (14%), and dietary fibre (10%), resulting in a Nutri-Score A. The truffle's volatile profile was dominated by eight-carbon volatile compounds, with 1-octen-3-ol being the most abundant (64%), and 29 compounds were reported for the first time for T. arenaria. T. arenaria's nutritional and chemical compositions were similar to those of four commercial mushroom and truffle species, while the aromatic profile was not. An electronic nose corroborated that T. arenaria's aromatic profile differs from that of the other four tested mushroom and truffle species. Our data showed that T. arenaria is a valuable food resource with a unique aroma and an analogous composition to meat, which makes it an ideal source for plant-based meat products. Our findings could help promote a sustainable future exploitation of T. arenaria and ensure the quality and authenticity of this delicacy.

Transcatheter systemic atrioventricular valve-in-valve implantation in a congenitally corrected transposition of the great arteries patient

We present an asymptomatic pregnant patient with congenitally corrected transposition of the great arteries and severe atrioventricular bioprosthesis regurgitation - with increased maternal and fetal risk due to volume overload. She was considered high risk for reintervention and was submitted to an off-label post-partum transcatheter valve-in-valve implantation with a Sapiens 3 valve. The procedure was successful, and she remains asymptomatic 30 months after - and even went through another successful pregnancy.

The Plant Growth-Promoting Potential of Halotolerant Bacteria Is Not Phylogenetically Determined: Evidence from Two Bacillus megaterium Strains Isolated from Saline Soils Used to Grow Wheat

(1) Background: Increasing salinity, further potentiated by climate change and soil degradation, will jeopardize food security even more. Therefore, there is an urgent need for sustainable agricultural practices capable of maintaining high crop yields despite adverse conditions. Here, we tested if wheat, a salt-sensitive crop, could be a good reservoir for halotolerant bacteria with plant growth-promoting (PGP) capabilities. (2) Methods: We used two agricultural soils from Algeria, which differ in salinity but are both used to grow wheat. Soil halotolerant bacterial strains were isolated and screened for 12 PGP traits related to phytohormone production, improved nitrogen and phosphorus availability, nutrient cycling, and plant defence. The four 'most promising' halotolerant PGPB strains were tested hydroponically on wheat by measuring their effect on germination, survival, and biomass along a salinity gradient. (3) Results: Two halotolerant bacterial strains with PGP traits were isolated from the non-saline soil and were identified as Bacillus subtilis and Pseudomonas fluorescens, and another two halotolerant bacterial strains with PGP traits were isolated from the saline soil and identified as B. megaterium. When grown under 250 mM of NaCl, only the inoculated wheat seedlings survived. The halotolerant bacterial strain that displayed all 12 PGP traits and promoted seed germination and plant growth the most was one of the B. megaterium strains isolated from the saline soil. Although they both belonged to the B. megaterium clade and displayed a remarkable halotolerance, the two bacterial strains isolated from the saline soil differed in two PGP traits and had different effects on plant performance, which clearly shows that PGP potential is not phylogenetically determined. (4) Conclusions: Our data highlight that salt-sensitive plants and non-saline soils can be reservoirs for halotolerant microbes with the potential to become effective and sustainable strategies to improve plant tolerance to salinity. However, these strains need to be tested under field conditions and with more crops before being considered biofertilizer candidates.

Synopsis of the Species of Coccidians Reported in Marine Fish

Eimeriid coccidians represent one of the largest groups of parasitic unicellular organisms and comprise many species of veterinary and medical importance. The aim of this work is to provide information, as complete as possible, concerning the oocyst phase of the species of coccidians (Apicomplexa: Eimeriorina) with four sporocysts, which were reported in marine fish. For each species, the accepted scientific name and respective authorities, its synonyms, reported hosts, site of infection (organ), and geographic distribution have been assembled. Available information on morphology (oocyst, sporocyst, and sporozoite) and GenBank accession numbers were also compiled. A total of 100 species of coccidians were described and reported from 60 families of marine fishes. Most species have been described from marine teleosts, with only 14 of the species described from marine elasmobranchs. Most of the species reported in marine fish belong to the genera Eimeria and Goussia, and only a handful belong to the genera Epieimeria, Calyptospora, and Crystallospora. Although marine coccidians have began to be described for more than one century, the collection of genetic data on marine fish coccidians only started in the 2010s and remains largely disconnected from the morphological analysis of specimens, which is available for only six formally described species.

It's a Family Affair: A Case for Consistency in Family Foundation Giving and Family Firm Community CSR Activity

Although most business-owning families (BOFs) that operate large family firms practice community social engagement both in private via family foundations and in the business domain via community corporate social responsibility (CSR) programs, the relationship between their activities in the two domains remains unclear. Prior literature speculates that BOFs will deprioritize firms' community CSR when they have family foundations as more efficient vehicles to achieve socioemotional wealth (SEW), which would imply that such BOFs are less ethical in operating their firms. We contrast these speculations by enriching the socioemotional wealth (SEW) approach with instrumental stakeholder theory and cue consistency arguments and theorize that BOFs seek to ensure consistency between their activities in the two domains. Using data from 2008 to 2018 on the 95 largest US public family firms whose BOFs also operate private foundations, we show a positive relationship between family foundation giving and firm community CSR activity. Furthermore, we provide evidence for the boundary conditions of this relationship, showing that it is weaker for firms that do not share the family's name and stronger for those firms with family leaders who also lead their families' foundations.

The world upside down - after 20 years of follow-up of dextro-transposition of the great arteries

Dextro-transposition of the great arteries (D-TGA) is a congenital heart disease (CHD) classically palliated with atrial switch (ATR-S) and nowadays corrected with arterial switch (ART-S). Our aim was to observe a group of D-TGA patients followed in an adult CHD outpatient clinic. We analyzed a group of D-TGA patients born between 1974 and 2001. Adverse events were defined as a composite of death, stroke, myocardial infarction or coronary revascularization, arrhythmia, and ventricular, baffle, or significative valvular dysfunction. A total of 79 patients were enrolled, 46% of whom were female, with a mean follow-up of 27±6 years after surgery. ATR-S was performed in 54% and ART-S in 46%; the median age at procedure was 13 months and 10 days, respectively. During follow-up, almost all ART-S remained in sinus rhythm versus 64% of ATR-S (p=0.002). The latter group had a higher incidence of arrhythmias (41% versus 3%, p<0.001), mostly atrial flutter or fibrillation; the median time to first arrhythmia was 23 years. Systemic ventricle systolic dysfunction (SVSD) was more frequent in ATR-S (41% versus 0%, p<0.001); the mean time to SVSD was 25 years. In ART-S, the most frequent complication was significant valvular regurgitation (14%). Regarding time-to-event analysis, 80% and 40% of ATR-S maintained adverse events-free after 20 and 30 years, respectively; the time-to-first adverse event was 23 years, and there was no difference compared to ART-S (Log-rank=0.596). ART-S tended to maintain more preserved biventricular function than ATR-S (Log-rank=0.055). After a long term free of adverse events, ATR-S patients experienced more arrhythmias and SVSD. ART-S complications were predominantly anastomosis-related; SVSD or arrhythmias were rare.

Comparing the toxicity of tungsten and vanadium oxide nanoparticles on Spirulina platensis

The production and release of nanoparticles and their impacts on living organisms are among the most important concerns in the world. Spirulina platensis was chosen because of its ability to absorb more elements than other algae. Therefore, an experiment was conducted to improve the product quality of spirulina exposed to new type of nanoparticles. In this experiment, vanadium oxide nanoparticles (VNPs) and tungsten oxide nanoparticles (WNPs) were used at concentrations of 0, 0.001, 0.017, and 0.05 g/l. The measured indices such as protein percentage and concentrations of phycobiliproteins and carbohydrates were the most important parameters of spirulina. Results showed that the concentration of 0.001 g/l of VNPs significantly affected the amounts of protein and phycocyanin. It has also been observed that 0.001 g/l of WNPs significantly influenced the amounts of protein (5.3%) and phycocyanin (90%); however, WNPs at all concentrations increased the concentrations of protein and phycocyanin. A concentration of 0.05 g/l of WNPs increased phycocyanin content by 83% over the control. The examination of nanoparticles by spirulina showed that VNPs were more adsorbed by spirulina than WNPs. In general, VNPs were toxic to algae at concentrations of 0.017 and 0.05 g/l, but WNPs did not show any fatal toxicity.

The Potential of Ectomycorrhizal Fungi to Modulate below and Aboveground Communities May Be Mediated by 1-Octen-3-ol

It is known that ectomycorrhizal (ECM) fungi can modulate below and aboveground communities. They are a key part of belowground communication as they produce a vast array of metabolites, including volatile organic compounds (VOCs) such as 1-octen-3-ol. Here, we tested if the VOC 1-octen-3-ol may be involved in the ECM fungal mechanisms that modulate below and aboveground communities. For that, we conducted three in vitro assays with ECM fungi and the 1-octen-3-ol volatile to (i) explore the effects of mycelium growth of three ECM species, (ii) investigate the impact on the germination of six host Cistaceae species, and (iii) study the impact on host plant traits. The effects of 1-octen-3-ol on mycelium growth of the three ECM species depended on the dose and species: Boletus reticulatus was the most sensitive species to the low (VOC) dose, while T. leptoderma was the most tolerant. In general, the presence of the ECM fungi resulted in higher seed germination, while 1-octen-3-ol resulted in lower seed germination. The combined application of the ECM fungus and the volatile further inhibited seed germination, possibly due to the accumulation of 1-octen-3-ol above the plant species' threshold. Seed germination and plant development of Cistaceae species were influenced by ECM fungal volatiles, suggesting that 1-octen-3-ol may mediate changes in below and aboveground communities.

Acute myocardial infarction during late COVID-19 era: patient characteristics, presentation and outcomes

COVID-19 pandemic has unquestionably influenced care of acute myocardial infarction (AMI). Still, its impact on patients (pts) characteristics, presentation, treatment, and outcomes remains not well established in late pandemic times. To address this issue, we performed a prospective study of type-1 AMI patients admitted in a tertiary care hospital. Pts were enrolled during 6-months in 2019 [n=122; pre-COVID-19 (PC) group] and in 2021 [n=196; late-COVID-19 (C) group]. Data was based on pts interview and review of medical records. Age and gender distribution, as well as ST/non-ST-elevation myocardial infarction (STEMI/NSTEMI) proportion and access to coronariography and revascularization were similar between groups. Group C patients presented more pre-existing established cardiovascular disease (CVD) (43% vs 30%; p=0.03); more frequent description of typical chest pain (94% vs 84%; p=0,002); higher levels of pain intensity, in a 0-10 scale (8±2 vs 7±2; p=0.02); higher frequencies of AMI complications (27% vs 15%; p=0.01) and worse Killip (K) class evolution (K≥2 in 22% C vs13% PC patients; p=0.05). In conclusion, late pandemic AMI patients presented worse in-hospital outcomes in our study, though pre-hospital and hospital care were comparable to pre-pandemic times. COVID patients had a higher burden of pre-existing established CVD and a more typical and intense symptom presentation. Therefore, it can be hypothesized that "sicker" patients continued to look for help when presenting AMI symptoms, while "less sick" patients and the ones with less typical and intense symptoms possibly avoided contact with health care services during late pandemic period.

The (dis)engagement of mangrove forests and mangrove rice in academic and non-academic literature on Guinea-Bissau-a systematic review protocol

BACKGROUND

Coastal areas in Guinea-Bissau and elsewhere in West Africa are bordered by mangrove forests. In several of these places, swaths of mangrove forest have been removed and the landscape has been technologically adapted for the production of mangrove rice-a regionally important staple. However, the effects of global warming, in particular sea-level rise, pose challenges to these socioecological environments. In this context, knowledge appears as an important resource and knowing what knowledge has been produced and which perspectives have guided that production may inform future responses to climate change. We have developed a systematic literature review protocol focusing on the main question: "How have mangrove forest and mangrove rice spaces been represented in the literature on Guinea-Bissau?" The main hypothesis is that although they occupy contiguous, interrelated and interactant spaces in coastal environments, mangrove forests and mangrove rice have been studied and analyzed independently in the literature.

METHODS

This is a protocol for conducting a systematic review that will include academic and non-academic literature in Portuguese, English and French. The academic literature will be retrieved from both Web of Science and Scopus using Boolean expressions. The non-academic literature will be accessed from relevant institutions, specialized libraries, and reference lists of previously selected items. Data extraction will follow a standard procedure based on an information sheet. Our analysis will be both qualitative (inductive and deductive coding, content analysis) and quantitative (word clouds, descriptive statistics and statistical testing).

DISCUSSION

This systematic review will provide information about the conceptual framework that has been produced through research, policymaking, and conservation and development programs in the management of coastal areas. This study will identify the limitations of previous approaches and contribute to both future research and strategies for planning adaptation to climate change. Finally, the outputs will add to broader debates about people-nature coexistence and climate change adaptation and mitigation.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

From a Lose-Lose to a Win-Win Situation: User-Friendly Biomass Models for Acacia longifolia to Aid Research, Management and Valorisation

Woody invasive species pose a big threat to ecosystems worldwide. Among them, Acacia longifolia is especially aggressive, fundamentally changing ecosystem structure through massive biomass input. This biomass is rarely harvested for usage; thus, these plants constitute a nuisance for stakeholders who invest time and money for control without monetary return. Simultaneously, there is an increased effort to valorise its biomass, e.g., for compost, growth substrate or as biofuel. However, to incentivise A. longifolia harvest and usage, stakeholders need to be able to estimate what can be obtained from management actions. Thus, the total biomass and its quality (C/N ratio) need to be predicted to perform cost-benefit analyses for usage and determine the level of invasion that has already occurred. Here, we report allometric biomass models for major biomass pools, as well as give an overview of biomass quality. Subsequently, we derive a simplified volume-based model (BM ~ 6.297 + 0.982 × Vol; BM = total dry biomass and Vol = plant volume), which can be applied to remote sensing data or with in situ manual measurements. This toolkit will help local stakeholders, forest managers or municipalities to predict the impact and valorisation potential of this invasive species and could ultimately encourage its management.

Oral Presentation No. 126 NOACs safety and efficacy in Adult Congenital Heart Disease

Introduction

Adult Congenital Heart Disease(ACHD) patients are an increasing population with known high risk for thromboembolic events.Validated scores are uncertain in this population. Although apparently safe, data is scarce about the use of NOAC.

Purpose

To evaluate all patients on-NOAC followed in an ACHD outpatients clinic and observe its safety and efficacy during a median follow-up of 34 months (IQR 7–60 months). Major bleeding was defined according to types 3 to 5 in BARC scale. Adverse event was defined as ≥ 1 of the follows: death, stroke, myocardial infarction, systemic embolism or major bleeding.

Results

A total of 65 patients were included, with a mean age of 52 ± 14 year-old, 66% female. Most frequent ACHD were atrial septal defect (22%) and tetralogy of Fallot (22%), followed by atrioventricular septal defect (17%) and transposition of great arteries (9%). Most patients had preserved biventricular function, 20% presented systemic ventricle systolic dysfunction and 12% subpulmonic ventricle systolic dysfunction. Atrial fibrillation or atrial flutter (AF/AFL) were the major reasons for anticoagulation (94%); the remaining were on NOAC due to previous ischaemic stroke, intra-cardiac thrombus or deep venous thrombosis. At the time of NOAC initiation, 49% had a CHA2DS2-VASc score ≥ 2 (median 1, IQR 1-3) and median HAS-BLED score was 0 (IQR 0-2);43% were medicated with apixaban, 29% with rivaroxaban,22% with edoxaban and 6% with dabigatran.During a median follow-up of 34 months, none had ischaemic complications or major bleeding and one patient died after pulmonic prothesis dysfunction surgery. Concerning time-to- adverse-event analysis, all patients kept uneventful after 2 years and more than 95% continued event-free after 8 years on-NOAC.

Identification of a Molecularly-Defined Subset of Breast and Ovarian Cancer Models that Respond to WEE1 or ATR Inhibition, Overcoming PARP Inhibitor Resistance

PURPOSE

PARP inhibitors (PARPi) induce synthetic lethality in homologous recombination repair (HRR)-deficient tumors and are used to treat breast, ovarian, pancreatic, and prostate cancers. Multiple PARPi resistance mechanisms exist, most resulting in restoration of HRR and protection of stalled replication forks. ATR inhibition was highlighted as a unique approach to reverse both aspects of resistance. Recently, however, a PARPi/WEE1 inhibitor (WEE1i) combination demonstrated enhanced antitumor activity associated with the induction of replication stress, suggesting another approach to tackling PARPi resistance.

EXPERIMENTAL DESIGN

We analyzed breast and ovarian patient-derived xenoimplant models resistant to PARPi to quantify WEE1i and ATR inhibitor (ATRi) responses as single agents and in combination with PARPi. Biomarker analysis was conducted at the genetic and protein level. Metabolite analysis by mass spectrometry and nucleoside rescue experiments ex vivo were also conducted in patient-derived models.

RESULTS

Although WEE1i response was linked to markers of replication stress, including STK11/RB1 and phospho-RPA, ATRi response associated with ATM mutation. When combined with olaparib, WEE1i could be differentiated from the ATRi/olaparib combination, providing distinct therapeutic strategies to overcome PARPi resistance by targeting the replication stress response. Mechanistically, WEE1i sensitivity was associated with shortage of the dNTP pool and a concomitant increase in replication stress.

CONCLUSIONS

Targeting the replication stress response is a valid therapeutic option to overcome PARPi resistance including tumors without an underlying HRR deficiency. These preclinical insights are now being tested in several clinical trials where the PARPi is administered with either the WEE1i or the ATRi.

Patient delay in acute myocardial infarction: a long journey still ahead

Background

It is overly known that time delays in acute myocardial infarction (AMI) strongly influence its outcomes. Patient delay (PD) is repeatedly pointed out as the longer one in this context, as well as it is the less modifiable one by organizational measures. Therefore, it is crucial to understand the reasons for longer PD in our population, to define proper strategies to improve PD and, ultimately, AMI-outcomes.

Methods

In this six-month prospective study of patients (pts) admitted in a tertiary hospital due to type-1 AMI, 194 pts were consecutively enrolled between May and October 2021. Data was based on a pts well-structured interview within 48h after admission and review of medical records.

Results

Our work spotted several aspects significantly influencing PD in AMI context (Figure 1). Concerning pts cardiovascular background, a trend towards a shorter PD was found in pts with at least one cardiovascular risk factor (CVRF) (p=0,08) and with a previous history of AMI (p=0,08). Regarding clinical presentation, a significantly shorter PD was found in pts presenting with associated symptoms (p=0,02), higher chest pain intensity (chest pain intensity ≥7 vs &lt;7 in a 0–10 scale; p=0,03) and symptoms onset on weekdays rather than weekends (p=0,003). Regarding pts knowledge, significant differences were found when pts recognized their symptoms as AMI, presenting a shorter PD in this context (p=0,006). Curiously, pts ability to correctly identify AMI symptoms, when asked, or to acknowledge their CVRF (when present), did not influence PD. Considering sociodemographic factors, higher incomes (p=0,03) and non-rural residence (p=0,03) significantly translated into shorter PD. No differences were found in PD according to pts age, gender or educational level. After this initial univariate analysis, multiple linear regression was performed to identify possible predictors of PD. Four variables were identified: pts ability to recognize their symptoms as AMI (β −0.199; 95% CI: −277 to −34,87; p=0.012), living in a non-rural residence (β 0.154; 95% CI: 0.12–161.44; p=0.05), presenting associated symptoms (β −0.194; 95% CI: −257.43 to −28.84; p=0.014) and occurrence of symptoms on weekdays (β 0.170; 95% CI: 12.73–259.49; p=0.031) predicted shorter patient delays.

Conclusion

Our study clearly points to the need for increasing public awareness and educational measures, mainly in pts living in rural areas, in order to: 1) Improve pts knowledge about AMI symptoms, clarifying that atypical symptoms can happen; 2) Reinforce the importance of shortening AMI time delays, clearly explaining the concept “time is muscle”.

Funding Acknowledgement

Type of funding sources: None.

The application of plant growth-promoting rhizobacteria in Solanum lycopersicum production in the agricultural system: a review

Food safety is a significant challenge worldwide, from plantation to cultivation, especially for perishable products such as tomatoes. New eco-friendly strategies are needed, and beneficial microorganisms might be a sustainable solution. This study demonstrates bacteria activity in the tomato plant rhizosphere. Further, it investigates the rhizobacteria's structure, function, and diversity in soil. Rhizobacteria that promote the growth and development of tomato plants are referred to as plant growth-promoting bacteria (PGPR). They form a series of associations with plants and other organisms in the soil through a mutualistic relationship where both parties benefit from living together. It implies the antagonistic activities of the rhizobacteria to deter pathogens from invading tomato plants through their roots. Some PGPR are regarded as biological control agents that hinder the development of spoilage organisms and can act as an alternative for agricultural chemicals that may be detrimental to the health of humans, animals, and some of the beneficial microbes in the rhizosphere soil. These bacteria also help tomato plants acquire essential nutrients like potassium (K), magnesium (Mg), phosphorus (P), and nitrogen (N). Some rhizobacteria may offer a solution to low tomato production and help tackle food insecurity and farming problems. In this review, an overview of soil-inhabiting rhizobacteria focused on improving the sustainable production of Solanum lycopersicum.

Spectra Fusion of Mid-Infrared (MIR) and X-ray Fluorescence (XRF) Spectroscopy for Estimation of Selected Soil Fertility Attributes

Previous works indicate that data fusion, compared to single data modelling can improve the assessment of soil attributes using spectroscopy. In this work, two different kinds of proximal soil sensing techniques i.e., mid-infrared (MIR) and X-ray fluorescence (XRF) spectroscopy were evaluated, for assessment of seven fertility attributes. These soil attributes include pH, organic carbon (OC), phosphorous (P), potassium (K), magnesium (Mg), calcium (Ca) and moisture contents (MC). Three kinds of spectra fusion (SF) (spectra concatenation) approaches of MIR and XRF spectra were compared, namely, spectra fusion-Partial least square (SF-PLS), spectra fusion-Sequential Orthogonalized Partial least square (SF-SOPLS) and spectra fusion-Variable Importance Projection-Sequential Orthogonalized Partial least square (SF-VIP-SOPLS). Furthermore, the performance of SF models was compared with the developed single sensor model (based on individual spectra of MIR and XRF). Compared with the results obtained from single sensor model, SF models showed improvement in the prediction performance for all studied attributes, except for OC, Mg, and K prediction. More specifically, the highest improvement was observed with SF-SOPLS model for pH [R2p = 0.90, root mean square error prediction (RMSEP) = 0.15, residual prediction deviation (RPD) = 3.30, and ratio of performance inter-quantile (RPIQ) = 3.59], successively followed by P (R2p = 0.91, RMSEP = 4.45 mg/100 g, RPD = 3.53, and RPIQ = 4.90), Ca (R2p = 0.92, RMSEP = 177.11 mg/100 g, RPD = 3.66, and RPIQ = 3.22) and MC (R2p = 0.80, RMSEP = 1.91%, RPD = 2.31, RPIQ = 2.62). Overall the study concluded that SF approach with SOPLS attained better performance over the traditional model developed with the single sensor spectra, hence, SF is recommended as the best SF method for improving the prediction accuracy of studied soil attributes. Moreover, the multi-sensor spectra fusion approach is not limited for only MIR and XRF data but in general can be extended for complementary information fusion in order to improve the model performance in precision agriculture (PA) applications.

Non-Toxic Increases in Nitrogen Availability Can Improve the Ability of the Soil Lichen Cladonia rangiferina to Cope with Environmental Changes

Climate change and atmospheric nitrogen (N) deposition on drylands are greatly threatening these especially vulnerable areas. Soil biocrust-forming lichens in drylands can provide early indicators of these disturbances and play a pivotal role, as they contribute to key ecosystem services. In this study, we explored the effects of different long-term water availability regimes simulating climate changes and their interaction with N addition on the physiological response of the soil lichen Cladonia rangiferina. Three sets of this lichen were subjected to control, reduced watering, and reduced watering and N addition (40 kg NH₄NO₃ ha⁻¹ year⁻¹) treatments for 16 months. Finally, all samples were subjected to daily hydration cycles with N-enriched water at two levels (40 and 80 kg NH₄NO₃ ha⁻¹ year⁻¹) for 23 days. We found that reduced watering significantly decreased the vitality of this lichen, whereas N addition unexpectedly helped lichens subjected to reduced watering to cope with stress produced by high temperatures. We also found that long-term exposure to N addition contributed to the acclimation to higher N availability. Overall, our data suggest that the interactions between reduced watering and increased N supply and temperature have an important potential to reduce the physiological performance of this soil lichen.

Modulation of the Wheat Seed-Borne Bacterial Community by Herbaspirillum seropedicae RAM10 and Its Potential Effects for Tryptophan Metabolism in the Root Endosphere

Plants and their associated microbiota share ecological and evolutionary traits that are considered to be inseparably woven. Their coexistence foresees the use of similar metabolic pathways, leading to the generation of molecules that can cross-regulate each other’s metabolism and ultimately influence plant phenotype. However, the extent to which the microbiota contributes to the overall plant metabolic landscape remains largely unexplored. Due to their early presence in the seed, seed-borne endophytic bacteria can intimately colonize the plant’s endosphere while conferring a series of phytobeneficial services to their host. Understanding the dynamics of these endophytic communities is a crucial step toward the formulation of microbial inoculants that can modulate the functionality of the plant-associated microbiota for improved plant fitness. In this work, wheat (Triticum aestivum) roots non-inoculated and inoculated with the bacterium Herbaspirillum seropedicae strain RAM10 were analyzed to explore the impact of inoculant–endophyte–wheat interrelationships on the regulation of tryptophan (Trp) metabolism in the endosphere environment. Root inoculation with H. seropedicae led to phylum-specific changes in the cultivable seed-borne endophytic community. This modulation shifted the metabolic potential of the community in light of its capacity to modulate the levels of key Trp-related metabolites involved in both indole-3-acetic acid (IAA) biosynthesis and in the kynurenine pathway. Our results support a mode of action of H. seropedicae relying on a shift in both the composition and functionality of the seed-borne endophytic community, which may govern important processes such as root growth. We finally provide a conceptual framework illustrating that interactions among roots, inoculants, and seed-borne endophytes are critical to fine-tuning the levels of IAA in the endosphere. Understanding the outcomes of these interactions is a crucial step toward the formulation of microbial inoculants based on their joint action with seed-borne endophytic communities to promote crop growth and health in a sustainable manner.

Small-scale agricultural grassland management can affect soil fungal community structure as much as continental scale geographic patterns

A European transect was established, ranging from Sweden to the Azores, to determine the relative influence of geographic factors and agricultural small-scale management on the grassland soil microbiome. Within each of five countries (factor ‘Country’), which maximized a range of geographic factors, two differing growth condition regions (factor ‘GCR’) were selected: a favorable region with conditions allowing for high plant biomass production and a contrasting less favorable region with a markedly lower potential. Within each region, grasslands of contrasting management intensities (factor ‘MI’) were defined: intensive and extensive, from which soil samples were collected. Across the transect, ‘MI’ was a strong differentiator of fungal community structure, having a comparable effect to continental scale geographic factors (‘Country’). ‘MI’ was also a highly significant driver of bacterial community structure, but ‘Country’ was clearly the stronger driver. For both, ‘GCR’ was the weakest driver. Also at the regional level, strong effects of MI occurred on various measures of the soil microbiome (i.e. OTU richness, management-associated indicator OTUs), though the effects were largely regional-specific. Our results illustrate the decisive influence of grassland MI on soil microbial community structure, over both regional and continental scales, and, thus, highlight the importance of preserving rare extensive grasslands.

The world upside down – after 20 years follow-up of dextro-transposition of the great arteries

Introduction

Congenital Heart Disease (CHD) affects under 1% of newborns and thanks to its prognosis improvement, most patients survive until adulthood. Dextro-transposition of the great arteries (dTGA) is a CHD classically palliated with atrial switch (ATS) procedure and nowadays corrected with an arterial switch (ARS), with better clinical outcomes. Nevertheless, several post-ATS patients remain alive and questions persist regarding their long-term prognosis.

Purpose

To observe a group of dTGA patients followed in an Adult CHD outpatients clinic, access their comorbidities, surgical interventions, complications and clinical outcomes.

Methods

We retrospectively analyzed a group of dTGA patients born between 1974 and 2001. Clinical features were collected and time-to-event statistics were analyzed. Adverse event was defined as at least one of the follows: death, stroke, myocardial infarction or coronary revascularization, arrhythmia and ventricular, valvular or conduct dysfunction.

Results

A total of 80 patients were enrolled with a mean follow-up of 26 years after surgery: 46% were female, median age 27 (19–57) year-old. Concerning other concomitant defects, 25% had ventricular septal defect, 12% pulmonary stenosis, 3% aortic coarctation and 1% single coronary ostium. ATS palliation was performed in 54% of patients (Senning procedure in 95%) and ARS (Jatene procedure) in 45% of patients; median age at procedure was 13 months and 10 days, respectively. During follow-up, almost all patients submitted to ARS remained in sinus rhythm (97%) versus 64% of ATS patients (p=0.037). The latter group had higher incidence of arrythmias (40% vs 3%, p=0.013), mostly atrial flutter or fibrillation (present in 28%), followed by bradyarrhythmia (10%); median time from surgery to first arrhythmic event in these patients was 23 years. Also, systemic ventricle systolic dysfunction (SVSD) and chronotropic incompetence were significantly higher in ATS (41% vs 3%, p&lt;0.001 and 46% vs 9%, p=0.005, respectively); mean time to SVSD was 29 years. In respect to long-term outcomes in ARS, the most frequent complications were moderate to severe aortic regurgitation, pulmonary stenosis and regurgitation, occurring in 21%, 7% and 3%, respectively. Concerning both groups, mean time to first adverse-event was 21 years. Regarding gender and demographic features, there were no differences in time-to-adverse-event, comparing patients living in urban versus rural neighbourhoods and female versus male (Log Rank, p=0.368 and p=0.693). Only one patient died, submitted to ATS, at 46 years-old, from chronic heart failure.

Conclusion

After a long-term free of events, ATS patients experienced more arrhythmic complications and SVSD. ARS complications were anastomosis related. This report highlights the efforts that should be made to identify late complication is this particular population. Of note, no demographic or gender differences were observed.

Funding Acknowledgement

Type of funding sources: None. Gender analysis

Clinical consequences of BRCA2 hypomorphism

The tumor suppressor FANCD1/BRCA2 is crucial for DNA homologous recombination repair (HRR). BRCA2 biallelic pathogenic variants result in a severe form of Fanconi anemia (FA) syndrome, whereas monoallelic pathogenic variants cause mainly hereditary breast and ovarian cancer predisposition. For decades, the co-occurrence in trans with a clearly pathogenic variant led to assume that the other allele was benign. However, here we show a patient with biallelic BRCA2 (c.1813dup and c.7796 A > G) diagnosed at age 33 with FA after a hypertoxic reaction to chemotherapy during breast cancer treatment. After DNA damage, patient cells displayed intermediate chromosome fragility, reduced survival, cell cycle defects, and significantly decreased RAD51 foci formation. With a newly developed cell-based flow cytometric assay, we measured single BRCA2 allele contributions to HRR, and found that expression of the missense allele in a BRCA2 KO cellular background partially recovered HRR activity. Our data suggest that a hypomorphic BRCA2 allele retaining 37–54% of normal HRR function can prevent FA clinical phenotype, but not the early onset of breast cancer and severe hypersensitivity to chemotherapy.

The Adaptive Power of Ammophila arenaria: Biomimetic Study, Systematic Observation, Parametric Design and Experimental Tests with Bimetal

The aim of our study was to apply a biomimetic approach, inspired by the Ammophila arenaria. This organism possesses a reversible leaf opening and closing mechanism that responds to water and salt stress (hydronastic movement). We adopted a problem-based biomimetic methodology in three stages: (i) two observation studies; (ii) how to abstract and develop a parametric model to simulate the leaf movement; and (iii) experiments with bimetal, a smart material that curls up when heated. We added creases to the bimetal active layer in analogy to the position of bulliform cells. These cells determine the leaf-closing pattern. The experiments demonstrated that creases influence and can change the direction of the bimetal natural movement. Thus, it is possible to replicate the Ammophila arenaria leaf-rolling mechanism in response to temperature variation and solar radiation in the bimetal. In future works, we will be able to propose responsive facade solutions based on these results.

Drought and salinity: A comparison of their effects on the ammonium-preferring species Spartina alterniflora

Drought and salinity are the most serious environmental factors affecting crop productivity worldwide; hence, it is important to select and develop both salt- and drought-tolerant crops. The perennial smooth cordgrass Spartina alterniflora Loisel is unusual in that it is highly salt-tolerant and seems to prefer ammonium (NH₄ ⁺ ) over nitrate (NO₃ ^- ) as an inorganic N source. In this study, we determined whether Spartina's unique preference for NH₄ ⁺ enhances performance under salt and drought stress. Greenhouse experiments were conducted to compare the interactive effects of N source, salinity, and low water availability on plant performance (growth and antioxidant metabolism). Drought significantly reduced growth and photosynthetic activity in S. alterniflora, more so with NH₄ ⁺ than NO₃ ^- ; in contrast, NH₄ ⁺ enhanced growth under high salinity. The increased tolerance of S. alterniflora to salt stress in the presence of NH₄ ⁺ was linked to a high level of antioxidant enzyme activity, combined with low MDA content, EL, and H₂ O₂ production. In contrast, drought stress negated the growth advantages for S. alterniflora exposed to salt stress in the presence of NH₄ ⁺ . The susceptibility of S. alterniflora to drought was partly due to reduced antioxidant enzyme activities, thereby reducing the defense against the oxidative damages induced by osmotic stress. In conclusion, in contrast to salt stress, drought stress negates the beneficial effects of ammonium as an N source in the C₄ plant Spartina alterniflora.

Phylogenetic Affinities and Infection Patterns of Goussia Infecting Sardina pilchardus from the NE Atlantic

PURPOSE

European pilchard (Sardina pilchardus) is a highly valued fish in many European countries, particularly in Portugal. Despite current stock declines and the threats coccidia pose to European pilchards (e.g. castration), little is known about coccidian parasites infecting pilchards captured off the Portuguese coast.

METHODS

In this study, we analyzed the infection patterns, the morphology of oocysts and the phylogenetic relations of coccidian parasites from European pilchard captured in Northern Portugal.

RESULTS

Only Goussia oocysts were detected in infected tissues and prevalence of infection was 64% (n = 61). Oocysts were detected primarily in the liver with fewer infections in the stomach, intestine and gonads. No differences were found in the prevalence between seasons. Phylogenetic analysis showed these parasites are closely related to Goussia clupearum, placing them within a recently described group of Goussia, the clupearum type.

CONCLUSIONS

Our study provides more data on Goussia from the clupearum type with phylogenetic analysis indicating that these parasites cluster according to fish host taxonomy, thus suggesting some degree of co-evolution.

Forebrain expression of serine racemase during postnatal development

N-methyl-D-aspartate receptors (NMDARs) are important for synaptogenesis, synaptic maturation and refinement during the early postnatal weeks after birth. Defective synapse formation or refinement underlie cognitive and emotional abnormalities in various neurodevelopmental disorders (NDDs), including schizophrenia (Sz) and autism spectrum disorder (ASD). Serine racemase (SR) is a neuronal enzyme that produces D-serine, a co-agonist required for full NMDAR activation. NMDAR hypofunction as a result of genetic SR elimination and reduced synaptic availability of D-serine reduces neuronal dendritic arborization and spine density. In adult mouse brain, the expression of SR parallels that of NMDARs across forebrain regions including the striatum, amygdala, hippocampus, and medial prefrontal cortex (mPFC). However, there have yet to be studies providing a detailed characterization of the spatial and temporal expression of SR during early periods of synaptogenesis. Here, we examined the postnatal expression of SR in cortical and subcortical brain regions important for learning, memory and emotional regulation, during the first four weeks after birth. Using dual-antigen immunofluorescence, we demonstrate that the number of SR+ neurons steadily increases with postnatal age across the mPFC, amygdala, hippocampus and striatum. We also identified differences in the rate of SR protein induction both across and within brain regions. Analyzing existing human post-mortem brain in situ data, there was a similar developmental mRNA expression profile of SRR and GRIN1 (GluN1 subunit) from infancy through the first decade of life. Our findings further support a developmental role for D-serine mediated NMDAR activation regulating synaptogenesis and neural circuit refinement, which has important implications for the pathophysiology of Sz and other NDDs.

Survey of Kudoa spp. (Myxozoa, Cnidaria) in fishes from the Madeira Archipelago and the Portuguese mainland coast: detection of Kudoa thyrsites in new hosts Scomber colias and Micromesistius poutassou

Myxozoan parasites of the genus Kudoa Meglitsch, 1947 are associated with post-mortem tissue degradation that causes great financial losses to commercial fisheries. Kudoa thyrsites (Gilchrist, 1924) is a species with a very wide host range including commercial tunas, mackerels, salmonids and flatfishes. A sample of 190 fishes of 18 species from the Madeira Archipelago and 30 Atlantic chub mackerel, Scomber colias Gmelin, and 30 blue whiting, Micromesistius poutassou (Risso), from the Portuguese mainland coast were examined for the presence of species of Kudoa. The prevalence of Kudoa spp. was 80% in M. poutassou and 60% in S. colias. No spore was detected in S. colias from Madeira, which was confirmed by specific PCR screening of the muscle from all individuals of S. colias. SSU rDNA analysis revealed that M. poutassou and S. colias from the Portuguese mainland coast were infected with K. thyrsites, an economically important myxozoan parasite. Both sequences were identical with sequences of the eastern Atlantic K. thyrsites genotype, including that from the type host of this parasite. This is the first report of K. thyrsites from M. poutassou and S. colias. The fact that spores of species of Kudoa were not detected in fishes screened in the Madeira Archipelago may be explained by various ecological factors, such as the absence of a continental shelf, a short insular shelf, and oceanic waters with low productivity, all resulting in reduced abundance of benthic organisms. Consequently, it is possible that as yet unknown annelid definitive hosts of Kudoa spp. are absent or very rare near Madeiran coasts.

Does age at aortic coarctation repair have an impact on left ventricle size and function?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Adults with repaired aortic coarctation (CoA) require lifelong follow-up due to late complications, including left ventricular (LV) myocardial dysfunction. Age at the time of CoA repair is an important prognostic factor in these patients (pts).

Purpose

To evaluate LV size, ejection fraction (EF) and global longitudinal strain (GLS) values using 2D speckle tracking echocardiography (STE) in a population of adult pts with repaired CoA and to assess the relationship between these echocardiographic parameters and age at the time of CoA repair.

Methods

Retrospective analysis of adult pts with repaired CoA, followed in a Grown Up Congenital Heart Disease Centre. Pts with hemodynamically significant concomitant cardiac lesions were ruled out. Epidemiologic and clinical data were obtained from clinical records. Transthoracic echocardiograms were reviewed in order to assess GLS using 2DSTE (Echopac Software, GE).

Results

The study population consisted of 63 pts (61.9% male), with a mean age of 35.3 years at the time of the echocardiographic evaluation. The mean age at the time of the CoA repair was 117 months (95% CI 89.8-144.1 months).

Surgical repair was performed in 46 pts (73%): resection with subclavian artery flap aortoplasty (n = 21); patch aortoplasty (n = 15) and head-to-head anastomosis (n = 10). In 10 pts there was no data regarding the type of surgical repair. Seven pts (11.1%) were submitted to percutaneous intervention (6 with aortic stent implantation and 1 with balloon aortic angioplasty).

Mean LVEF was 63.4% (CI 95% 55.6 – 71.2%) and mean LV end-diastolic diameter (LVEDD) was 50mm (CI 95% 43-57mm). Mean GLS was - 17.3 (CI 95% 14.8- 19.8), which is inferior to the mean normal values reported for the software used.

Age at the time of CoA repair had a statistically significant positive linear relationship with LVEDD (r= 0.282; p= 0.026) and a linear negative relationship with both GLS (r= -0,29; p= 0.022) and LVEF (r= -0.33; p= 0.05).

Conclusion

Older age at the time of CoA repair was associated with increased LVEDD and decreased GLS and LVEF. Also, GLS may be an important tool for the identification of subclinical LV dysfunction in adult pts with repaired CoA.

A Phase I/II Clinical Trial to evaluate the efficacy of baricitinib to prevent respiratory insufficiency progression in onco-hematological patients affected with COVID19: A structured summary of a study protocol for a randomised controlled trial

OBJECTIVES

Baricitinib is supposed to have a double effect on SARS-CoV2 infection. Firstly, it reduces the inflammatory response through the inhibition of the Januse-Kinase signalling transducer and activator of transcription (JAK-STAT) pathway. Moreover, it reduces the receptor mediated viral endocytosis by AP2-associated protein kinase 1 (AAK1) inhibition. We propose the use of baricinitib to prevent the progression of the respiratory insufficiency in SARS-CoV2 pneumonia in onco-haematological patients. In this phase Ib/II study, the primary objective in the safety cohort is to describe the incidence of severe adverse events associated with baricitinib administration. The primary objective of the randomized phase (baricitinib cohort versus standard of care cohort) is to evaluate the number of patients who did not require mechanical oxygen support since start of therapy until day +14 or discharge (whichever it comes first). The secondary objectives of the study (only randomized phase of the study) are represented by the comparison between the two arms of the study in terms of mortality and toxicity at day+30. Moreover, a description of the immunological related changes between the two arms of the study will be reported.

TRIAL DESIGN

The trial is a phase I/II study with a safety run-in cohort (phase 1) followed by an open label phase II randomized controlled trial with an experimental arm compared to a standard of care arm.

PARTICIPANTS

The study will be performed at the Institut Català d'Oncologia, a tertiary level oncological referral center in the Catalonia region (Spain). The eligibility criteria are: patients > 18 years affected by oncological diseases; ECOG performance status < 2 (Karnofsky score > 60%); a laboratory confirmed infection with SARS-CoV-2 by means of real -time PCR; radiological signs of low respiratory tract disease; absence of organ dysfunction (a total bilirubin within normal institutional limits, AST/ALT≤2.5 X institutional upper limit of normal, alkaline phosphatase ≤2.5 X institutional upper limit of normal, coagulation within normal institutional limits, creatinine clearance >30 mL/min/1.73 m² for patients with creatinine levels above institutional normal); absence of HIV infection; no active or latent HBV or HCV infection. The exclusion criteria are: patients with oncological diseases who are not candidates to receive any active oncological treatment; hemodynamic instability at time of study enrollment; impossibility to receive oral medication; medical history of recent or active pulmonary embolism or deep venous thrombosis or patients at high-risk of suffering them (surgical intervention, immobilization); multi organ failure, rapid worsening of respiratory function with requirement of fraction of inspired oxygen (FiO₂) > 50% or high-flow nasal cannula before initiation of study treatment; uncontrolled intercurrent illness (ongoing or severe active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements); allergy to one or more of study treatments; pregnant or breastfeeding women; positive pregnancy test in a pre-dose examination. Patients should have the ability to understand, and the willingness to sign, a written informed consent document; the willingness to accept randomization to any assigned treatment arm; and must agree not to enroll in another study of an investigational agent prior to completion of Day +28 of study. An electronic Case Report Form in the Research Electronic Data Capture (REDCap) platform will be used to collect the data of the trial. Removal from the study will apply in case of unacceptable adverse event(s), development of an intercurrent illness, condition or procedural complication, which could interfere with the patient's continued participation and voluntary patient withdrawal from study treatment (all patients are free to withdraw from participation in this study at any time, for any reasons, specified or unspecified, and without prejudice).

INTERVENTION AND COMPARATOR

Treatment will be administered on an inpatient basis. We will compare the experimental treatment with baricitinib plus the institutional standard of care compared with the standard of care alone. During the phase I, we will define the dose-limiting toxicity of baricitinib and the dose to be used in the phase 2 part of the study. The starting baricitinib dose will be an oral tablet 4 mg-once daily which can be reduced to 2 mg depending on the observed toxicity. The minimum duration of therapy will be 5 days and it can be extended to 7 days. The standard of care will include the following therapies. Antibiotics will be individualized based on clinical suspicion, including the management of febrile neutropenia. Prophylaxis of thromboembolic disease will be administered to all participants. Remdesivir administration will be considered only in patients with severe pneumonia (SatO₂ <94%) with less than 7 days of onset of symptoms and with supplemental oxygen requirements but not using high-flow nasal cannula, non-invasive or invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO). In the randomized phase, tocilizumab or interferon will not be allowed in the experimental arm. Tocilizumab can be used in patients in the standard of care arm at the discretion of the investigator. If it is prescribed it will be used according to the following criteria: patients who, according to his baseline clinical condition, would be an ICU tributary, interstitial pneumonia with severe respiratory failure, patients who are not on mechanical ventilation or ECMO and who are still progressing with corticoid treatment or if they are not candidates for corticosteroids. Mild ARDS (PAFI <300 mmHg) with radiological or blood gases deterioration that meets at least one of the following criteria: CRP >100mg/L D-Dimer >1,000μg/L LDH >400U/L Ferritin >700ng/ml Interleukin 6 ≥40ng/L. The use of tocilizumab is not recommended if there are AST/ALT values greater than 10 times the upper limit of normal, neutrophils <500 cells/mm3, sepsis due to other pathogens other than SARS-CoV-2, presence of comorbidity that can lead to a poor prognosis, complicated diverticulitis or intestinal perforation, ongoing skin infection. The dose will be that recommended by the Spanish Medicine Agency in patients ≥75Kg: 600mg dose whereas in patients <75kg: 400mg dose. Exceptionally, a second infusion can be assessed 12 hours after the first in those patients who experience a worsening of laboratory parameters after a first favourable response. The use of corticosteroids will be recommended in patients who have had symptoms for more than 7 days and who meet all the following criteria: need for oxygen support, non-invasive or invasive mechanical ventilation, acute respiratory failure or rapid deterioration of gas exchange, appearance or worsening of bilateral alveolar-interstitial infiltrates at the radiological level. In case of indication, it is recommended: dexamethasone 6mg/d p.o. or iv for 10 days or methylprednisolone 32mg/d orally or 30mg iv for 10 days or prednisone 40mg day p.o. for 10 days.

MAIN OUTCOMES

Phase 1 part: to describe the toxicity profile of baricitinib in COVID19 oncological patients during the 5-7 day treatment period and until day +14 or discharge (whichever it comes first). Phase 2 part: to describe the number of patients in the experimental arm that will not require mechanical oxygen support compared to the standard of care arm until day +14 or discharge (whichever it comes first).

RANDOMISATION

For the phase 2 of the study, the allocation ratio will be 1:1. Randomization process will be carried out electronically through the REDcap platform ( https://www.project-redcap.org/ ) BLINDING (MASKING): This is an open label study. No blinding will be performed.

NUMBERS TO BE RANDOMISED (SAMPLE SIZE)

The first part of the study (safety run-in cohort) will consist in the enrollment of 6 to 12 patients. In this population, we will test the toxicity of the experimental treatment. An incidence of severe adverse events grade 3-4 (graded by Common Terminology Criteria for Adverse Events v.5.0) inferior than 33% will be considered sufficient to follow with the next part of the study. The second part of the study we will perform an interim analysis of efficacy at first 64 assessed patients and a definitive one will analyze 128 assessed patients. Interim and definitive tests will be performed considering in both cases an alpha error of 0.05. We consider for the control arm this rate is expected to be 0.60 and for the experimental arm of 0.80. Considering this data, a superiority test to prove a difference of 0.20 with an overall alpha error of 0.10 and a beta error of 0.2 will be performed. Considering a 5% of dropout rate, it is expected that a total of 136 patients, 68 for each study arm, will be required to complete study accrual.

TRIAL STATUS

Version 5.0. 14^th October 2020 Recruitment started on the 16^th of December 2020. Expected end of recruitment is June 2021.

TRIAL REGISTRATION

AEMPs: 20-0356 EudraCT: 2020-001789-12, https://www.clinicaltrialsregister.eu/ctr-search/search (Not publically available as Phase I trial) Clinical trials: BARCOVID19, https://www.clinicaltrials.gov/ (In progress) FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol."

Microbial consortium increases maize productivity and reduces grain phosphorus concentration under field conditions

BACKGROUND

The use of microbes that improve plant phosphorus (P) use efficiency is an avenue to boost crop yields while alleviating environmental impacts. We tested three microbial inoculants (Rhizoglomus irregulare alone - designated AMF; Pseudomonas putida alone - designated PSB; and R. irregulare and P. putida in consortium - designated AMF+PSB), combined with chemical fertilizers, in an intensive maize agricultural system.

RESULTS

As hypothesized: (i) despite the native soil microbial community and the application of P fertilizer, the microbial inoculants enhanced plant P uptake from the soil by 14-60%, and consequently improved P acquisition efficiency; (ii) PSB and AMF+PSB plants produced ±50% more biomass per unit of P taken up, and consequently enhanced plant internal P use efficiency (i.e. the biomass produced per unit of P); and (iii) the combined inoculation of AMF and PSB provided the best results in terms of productivity and P use efficiency. Further, the microbial inoculants altered P allocation within the plant, reducing grain P concentration.

CONCLUSION

By testing the microbial inoculants under field conditions, our study clearly shows that the microbial consortium (AMF+PSB) increased maize productivity, and at the same time improved P use efficiency. Further, the use of these microbial inoculants was shown to be compatible with conventional agricultural management practices.

Plasma membrane H+ pump at a crossroads of acidic and iron stresses in yeast-to-hypha transition

Iron is an essential nutrient but is toxic in excess mainly under acidic conditions. Yeasts have emerged as low cost, highly efficient soil inoculants for the decontamination of metal-polluted areas, harnessing an increasing understanding of their metal tolerance mechanisms. Here, we investigated the effects of extracellular iron and acid pH stress on the dimorphism of Yarrowia lipolytica. Its growth was unaffected by 1 or 2 mM FeSO4, while a strong cellular iron accumulation was detected. However, the iron treatments decreased the hyphal length and number, mainly at 2 mM FeSO4 and pH 4.5. Inward cell membrane H+ fluxes were found at pH 4.5 and 6.0 correlated with a pH increase at the cell surface and a conspicuous yeast-to-hypha transition activity. Conversely, a remarkable H+ efflux was detected at pH 3.0, related to the extracellular microenvironment acidification and inhibition of yeast-to-hypha transition. Iron treatments intensified H+ influxes at pH 4.5 and 6.0 and inhibited H+ efflux at pH 3.0. Moreover, iron treatments inhibited the expression and activities of the plasma membrane H+-ATPase, with the H+ transport inhibited to a greater extent than the ATP hydrolysis, suggesting an iron-induced uncoupling of the pump. Our data indicate that Y. lipolytica adaptations to high iron and acidic environments occur at the expense of remodelling the yeast morphogenesis through a cellular pH modulation by H+-ATPases and H+ coupled transporters, highlighting the capacity of this non-conventional yeast to accumulate high amounts of iron and its potential application for bioremediation.

Coronary artery fistulas: a single-center case series

Introduction

Coronary artery fistulas (CAFs) are rare anomalous connections between a coronary artery and a major vessel or cardiac chamber. Currently they are being increasingly encountered due to the more widespread use of various imaging modalities and coronary angiography. Although the vast majority of CAFs are incidentally diagnosed and have no clinical relevance, they can cause significant morbidity such as myocardial infarction, congestive heart failure and endocarditis.

Methods

A consecutive series of 55867 coronary arteriograms performed in our Cardiology Department from 2007 to 2019 was retrospectively investigated for the presence of coronary artery fistulas. Patients clinical, angiographic and therapeutic data up to november 2019 were analyzed. Data were obtained from medical records of hospital stay and subsequent consultations.

Results

We identified 50 patients who were diagnosed with one or more CAFs, with ages between 5 and 85 years (mean 59 years). 62% (n=31) were males.

The great majority of patients had a single fistula (n=34, 68%), 11 patients had two fistulas (22%), 1 patient had 3 fistulas (2%) and 4 patients had multiple fistulas (8%).

CAFs arose more frequently from the left anterior descending artery (n=27), followed by the right coronary (n=18), left circumflex (n=15), left main (n=5) and intermediate artery (n=2). The most frequent drainage site was the pulmonary artery (n=38).

The majority of CAFs were incidentally found (n=32; 64%) and thought to have no significance for the patients' clinical status. As for the rest of the patients, CAFs were diagnosed during evaluation of: a heart murmur (n=7); exertional chest pain with no associated significant atherosclerotic coronary artery disease (n=7); exertional dyspnea (n=2); positive exercise stress test (n=1); NSTEMI and cardiac arrest (n=1).

Regarding treatment, watchful waiting was the main approach (n=40; 80%). 3 patients had their CAFs closed during surgery for another heart condition (CABG/aortic valve replacement). In 1 patient, heart surgery was specifically conducted for fistula closure. 6 patients (12%) underwent fistula transcatheter closure.

Conclusion

CAFs are rare coronary anomalies and the majority has no clinical relevance, so watchful waiting is the commonest approach. When they are hemodynamically significant or symptoms/complications arise, surgical or transcatheter closure should be considered. This study describes the angiographic, clinical and therapeutic data of CAFs detected along the last 12 years in a single tertiary care center catheterization laboratory.

Funding Acknowledgement

Type of funding source: None

Inoculation with the endophytic bacterium Herbaspirillum seropedicae promotes growth, nutrient uptake and photosynthetic efficiency in rice

Higher vacuolar proton pump activity may increase plant energy and nutrient use efficiency and provide the nexus between plant inoculation with Herbaspirillum seropedicae and growth promotion. Global change and growing human population are exhausting arable land and resources, including water and fertilizers. We present inoculation with the endophytic plant-growth promoting bacterium (PGPB) Herbaspirillum seropedicae as a strategy for promoting growth, nutrient uptake and photosynthetic efficiency in rice (Oryza sativa L.). Because plant nutrient acquisition is coordinated with photosynthesis and the plant carbon status, we hypothesize that inoculation with H. seropedicae will stimulate proton (H⁺) pumps, increasing plant growth nutrient uptake and photosynthetic efficiency at low nutrient levels. Plants were inoculated and grown in pots with sterile soil for 90 days. Herbaspirillum seropedicae endophytic colonization was successful and, as hypothesized, inoculation (1) stimulated root vacuolar H⁺ pumps (vacuolar H⁺-ATPase and vacuolar H⁺-PPase), and (2) increased plant growth, nutrient contents and photosynthetic efficiency. The results showed that inoculation with the endophytic bacterium H. seropedicae can promote plant growth, nutrient uptake and photosynthetic efficiency, which will likely result in a more efficient use of resources (nutrients and water) and higher production of nutrient-rich food at reduced economic and environmental costs.

Recommendations for genetic testing in cardiology: Review of major international guidelines

In recent years, the importance of genetic causes of cardiovascular diseases has been increasingly recognized, as the result of significant advances in molecular diagnosis techniques. This growing knowledge has enabled the identification of new phenotypes and the subclassification of clinical syndromes, impacting the therapeutic approach and genetic counseling offered to affected families. This paper describes the state of the art of genetic testing in the main cardiovascular diseases, aiming to provide a useful tool to help cardiologists and other health professionals involved in the care of individuals with hereditary heart diseases and their families.

The Free-Living Stage Growth Conditions of the Endophytic Fungus Serendipita indica May Regulate Its Potential as Plant Growth Promoting Microbe

Serendipita indica (former Piriformospora indica) is a non-obligate endophytic fungus and generally a plant growth and defence promoter with high potential to be used in agriculture. However, S. indica may switch from biotrophy to saprotrophy losing its plant growth promoting traits. Our aim was to understand if the free-living stage growth conditions (namely C availability) regulate S. indica’s phenotype, and its potential as plant-growth-promoting-microbe (PGPM). We grew S. indica in its free-living stage under increasing C availabilities (2–20 g L^–1 of glucose or sucrose). We first characterised the effect of C availability during free-living stage growth on fungal phenotype: colonies growth and physiology (plasma membrane proton pumps, stable isotopic signatures, and potential extracellular decomposing enzymes). The effect of the C availability during the free-living stage of the PGPM was evaluated on wheat. We observed that C availability during the free-living stage regulated S. indica’s growth, ultrastructure and physiology, resulting in two distinct colony phenotypes: compact and explorer. The compact phenotype developed at low C, used peptone as the major C and N source, and displayed higher decomposing potential for C providing substrates; while the explorer phenotype developed at high C, used glucose and sucrose as major C sources and casein and yeast extract as major N sources, and displayed higher decomposing potential for N and P providing substrates. The C availability, or the C/N ratio, during the free-living stage left a legacy to the symbiosis stage, regulating S. indica’s potential to promote plant growth: wheat growth promotion by the explorer phenotype was ± 40% higher than that by the compact phenotype. Our study highlights the importance of considering microbial ecology in designing PGPM/biofertilizers. Further studies are needed to test the phenotypes under more extreme conditions, and to understand if the in vitro acquired characteristics persist under field conditions.

A systematic review on resource allocation in public health

Background

Research in resource allocation is a need arising from State interference by the allocative function, which seeks to promote resource adjustments with the provision of certain goods and public services (Musgrave, 1974; Musgrave & Musgrave, 1980, Longo & Troster, 1993). In this perspective, a research question arises: how has international literature on the field of Business, Management and Accounting been approaching resource allocation in public health?

Methods

Systematic Literature Review through the Scopus Database. keywords: “public health” and “resource allocation”. The types were Article and Review. Language: English, since it is internationally accepted in scientific articles, and Portuguese, in order to include Brazilian research. Search period: from 1976 to 2017. Areas: “Business, Management and Accounting”. The performed analysis technique was qualitative meta-synthesis and by using the MAXQDA Analytics Pro 18 software.

Results

The first identified study was in 2000 Sweden, pulished in Health Care Management Science. The most recente in 2017 Brazil, published in Evaluation and Program Planning. Among the countries that presented the largest production, the United States is highlighted (4). Dispersion of publication among reviews was noted. Generally, publications are grouped in four perspectives: adequate allocation, resource management and effective cost; resource allocation for treating specific diseases; resource allocation for decision-making; and health evaluation and the need of informing resource allocation. The prevailing lack of theoretical grounding must be highlighted.

Conclusions

Can be inferred that this production is recent, that it does not possess a specific focus or outline, as there is a variety of approaches, most of them being geared towards healthcare and disease control, such as cancer, diabetes, overweight, rabies, malaria and infectious diseases.

Key messages

International literature indicates that the theme is yet unexplored in the field of Business, Management e Accounting and most studies are geared towards healthcare and disease control. Allocation in the public-health policy as a function of the role of the State in providing the necessary budget for financial availability and not cost-wise, suggests lack of research.

The distribution of herbivores between leaves matches their performance only in the absence of competitors

Few studies have tested how plant quality and the presence of competitors interact in determining how herbivores choose between different leaves within a plant. We investigated this in two herbivorous spider mites sharing tomato plants: Tetranychus urticae, which generally induces plant defenses, and Tetranychus evansi, which suppresses them, creating asymmetrical effects on coinfesting competitors. On uninfested plants, both herbivore species preferred young leaves, coinciding with increased mite performance. On plants with heterospecifics, the mites did not prefer leaves on which they had a better performance. In particular, T. urticae avoided leaves infested with T. evansi, which is in agreement with T. urticae being outcompeted by T. evansi. In contrast, T. evansi did not avoid leaves with the other species, but distributed itself evenly over plants infested with heterospecifics. We hypothesize that this behavior of T. evansi may prevent further spread of T. urticae over the shared plant. Our results indicate that leaf age determines within-plant distribution of herbivores only in absence of competitors. Moreover, they show that this distribution depends on the order of arrival of competitors and on their effects on each other, with herbivores showing differences in behavior within the plant as a possible response to the outcome of those interactions.