Characterization of Opioid Use in the Intensive Care Unit and Its Impact Across Care Transitions: A Prospective Study.

PURPOSE: The objective of this study is to characterize opioid intensity in the intensive care unit (ICU) and its association with opioid utilization across care transitions. METHODS: This is a prospective cohort study. Medically ill ICU patients with complete medication histories who survived to discharge were included. Opioid intensity was characterized based on IV morphine milligram equivalents (IV MME). Primary outcomes were opioid prescribing upon ICU and hospital discharge. RESULTS: Opioids were prescribed to 34.1% and 31.1% of patients upon ICU and hospital discharge. Within the ≥50 mean IV MME/ICU day cohort, 64.7% of patients received opioids after ICU discharge compared to 45.8% and 13.6% in the 1-49 mean IV MME/ICU day and no opioid groups (P < .05). Within the ≥50 mean IV MME/ICU day cohort, 70.6% of patients were prescribed opioids after hospitalization compared to 37.3% and 13.6% of patients who received less or no opioids. (P < .05). Within the ≥50 mean IV MME/ICU day cohort, 29.4% of patients were opioid naïve and discharged with an opioid, which is over double compared to patients with lower opioid requirements (P < .05). CONCLUSION: Patients with higher mean daily ICU opioid requirements had increased opioid prescribing across care transitions despite preadmission opioid use.

Surgical management of choroid plexus papilloma of the cerebellopontine and cerebellomedullary angle: classification and strategy.

Choroid plexus papillomas (CPPs) are primary neuroectodermal neoplasms that usually arise in the fourth ventricle in adults. In this study, we present 12 patients with CPP arising from the cerebellopontine angle (CPP-CPA) and/or of the cerebellomedullary angle (CPP-CMA) that were treated in our department. Patients who underwent surgery for the treatment for CPP-CPA/CMA from January 2004 to March 2020 were identified by a computer search of their files from the Department of Neurosurgery, Tübingen. CPPs were classified according to their location into type 1 (tumor portion only in the CPA,), type 2 (tumor portions only in the CMA), and type 3 (tumor portions both in the CPA and CMA). Patients were evaluated for initial symptoms, previous therapies in other hospitals, extent of tumor resection, recurrence rate, and complications by reviewing patient documents. Of approximately 1500 CPA lesions, which were surgically treated in our department in the last 16 years, 12 patients (mean age 42 ± 19 years) were found to have CPP-CPA/CMA. Five were male, and seven were female patients. Gross total resection was achieved in nine cases, and a subtotal resection was attained in three cases. Tumor recurrence in the same location after the first surgery in our hospital was observed in 2 patients after 15 and 40 months of follow-up, and in another patient, distant metastases (C3/4 and L3 levels) were observed. Surgical removal of CPP is the treatment of choice, but additional therapeutic options may be necessary in case of remnant tumor portions, recurrence, or malignant transformation.

Catastrophic antiphospholipid syndrome as a complication of systemic sclerosis.

A 62-year-old man with a history of systemic sclerosis was admitted with diffuse alveolar hemorrhage and acute kidney injury without clinical data suggestive of glomerulonephritis. Laboratory tests showed anemia, leukocytosis with neutrophilia, thrombocytopenia, elevated serum creatinine and metabolic acidosis. Antinuclear antibodies were positive at a titer of 1/640 (speckled, 1/160; nucleolar, 1/320) while rheumatoid factor, anti Scl-70, anti-centromere, anti-neutrophil cytoplasmic antibody and anti-glomerular basement membrane antibodies were negative and serum complement levels were within normal range. During the following days, the patient developed multiple organ failure and, eventually, died. Lupus anticoagulant was revealed positive after the patient's death, suggesting a catastrophic antiphospholipid syndrome. Clinical data and autopsy were consistent with this diagnosis.

The role of flagship species in the economic valuation of wildfire impacts: An application to two Mediterranean protected areas.

Disturbance events play an important role in ecosystem services management and species biodiversity. In this sense, species biodiversity may constitute a large proportion of the total ecosystem value, mainly in natural protected areas. The present research proposes a methodology for the economic valuation of flagship species; the value of charismatic species was estimated using two complementary approaches based on recovery programs and contingent valuation method (CVM). While recovery programs approach is related to government expenditure, CVM is associated with survey results according to the society's willingness to pay. There are significant differences between both approaches as flagship species are highly valued by the society. In this sense, a difference of 43.75% on the species value can be found depending on the scenario of CVM (all respondents or only affirmative respondents). Our research was done on the integration of economic tools and wildfire severity of two burned areas in order to evaluate the effects caused in their habitat and, as a consequence, in the food chain. The results obtained from both the studied areas emphasized the importance of wildfire impacts on flagship species (209,619.08-445,495.88 € from Doñana wildfire and 634.68-5792.98 € from Segura wildfire) which are often omitted in valuation reports. The use of Geographic Information Systems helps to identify flagship species impacts per unit area (74.89-159.17 €/ha from Doñana wildfire and 0.76-6.98 €/ha from Segura wildfire) and to prioritize restoration activities on the most susceptible areas. This methodology could be extrapolated to any territory and spatial resolution based on the revision of the questionnaires regarding flagship species. The availability of cartography of flagship species´ susceptibility could play a critical role in budget optimization and the decision-making process on restoration planning.

Embryo sHLA-G secretion is related to pregnancy rate.

SummaryHLA-G expression has been detected in early preimplantation embryos and it has been postulated that a relationship between embryonic expression of this factor and successful pregnancy may exist. Forty-six patients were prospectively selected from our centre 'Unidad de Reproducción Humana, Hospital Universitario de Canarias' for conducting this study. In all cases, metaphase II (MII) oocytes were fertilized using intracytoplasmic sperm injection 2-4 h after retrieval. Embryos were cultured individually in 20 µl droplets of G-1 medium (VitroLife) under oil at 37°C and a 6% CO2 environment. Fertilization was assessed at 18 h postinsemination and all oocytes fertilized were passed into a new culture plaque individually in 300 µl culture medium until day 3 of culture. The culture medium was examined for the expression and secretion of sHLA-G with a sandwich enzyme-linked immunosorbent assay kit (BioVendor, Heidelberg, Germany) according to the manufacturer's instructions. We found statistical significance between higher levels of sHLA-G secretion and pregnancy rate. When both groups were compared there was no difference in embryo quality of transferred embryos, but a significant difference in the number of oocytes and the embryo quality of the cohort existed that was greater in the pregnant group. A standardized sHLA-G assay with a specifically defined range and standard units provides a non-invasive method to identify the most competent embryos for transfer.

Identifying the abiotic and biotic drivers behind the elevational distribution shift of a parasitic plant.

Climate change will alter the biotic and abiotic environment and dissipate ecological barriers, reorganising maps of current distribution of parasites and their hosts. In this study, we analyse the population dynamics of the parasitic plant Viscum album subsp. austriacum and explore key biotic (host availability and seed dispersal) as well as abiotic (temperature) factors influencing elevational distribution. The study was conducted along an elevational gradient of a Mediterranean mountain, covering the distribution belts of three potential pine hosts: Pinus halepensis (1300-1500 m), P. nigra (1300-1900 m) and P. sylvestris var. nevadensis (1600-2000 m). Along this gradient, we measured multiple variables of mistletoe population (prevalence, abundance and demographic profile) and different factors that might define the current mistletoe distribution (host suitability and availability, temperature and seed dispersal services). We found a decline in mistletoe prevalence and abundance with increasing elevation, detecting larger values of both variables at lower elevations of the most suitable host (Pinus nigra). Pinus sylvestris var. nevadensis was a suboptimal but suitable host for the parasite at high elevations. Mistletoe found suitable temperatures and seed dispersal services all along the gradient, being able to recruit at any site. With warming temperatures, the presence of suitable vectors for parasite dispersion, and the presence of a sub-optimal host (P. sylvestris var. nevadensis) at the mountain top, mistletoe currently has a window of opportunity to expand its present geographic distribution to the summits.

Food Processing Antioxidants.

Food processing has been carried out since ancient times as a way to preserve and improve food nutritional and organoleptic properties. Although it has some undesirable consequences, such as the losses of some nutrients and the potential formation of toxic compounds, a wide range of benefits can be enumerated. Among them, the increased total antioxidant capacity of many processed foods has been known for long. This consequence has been related to both the release or increased availability of natural antioxidants and the de novo formation of substances with antioxidant properties as a consequence of the produced reactions. This review analyzes the chemical changes produced in foods during processing with special emphasis on the formation of antioxidants as a consequence of carbonyl-amine reactions produced by both carbohydrate- and lipid-derived reactive carbonyls. It discusses the lastest advances produced in the characterization of carbonyl-amine adducts and their potential action as primary (free radical scavengers), secondary (chelating and other ways to prevent lipid oxidation), and tertiary (carbonyl scavengers as a way to avoid lipid oxidation consequences) antioxidants. Moreover, the possibility of combining amino compounds with different hydrophobicity, such as aminophospholipids and proteins, with a wide array of reactive carbonyls points out to the use of carbonyl-amine reactions as a new way to induce the formation of a great variety of substances with antioxidant properties and very variable hydrophilia/lipophilia. All presented results point out to carbonyl-amine reactions as an effective method to generate efficacious antioxidants that can be used in food technology.

[Placental site trophoblastic tumor with atypical choriocarcinoma. Case Report]. / Tumor trofoblástico del sitio placentario con evolución a coriocarcinoma. Caso clínico.

BACKGROUND: The placental site trophoblastic tumor is the second rarest tumor of trophoblastic disease, with less than 300 cases reported. Clinical presentation it's a diagnostic challenge, it has an unpredictable malignant potential, and it can develop choriocarcinoma and even have simultaneous presentation. CASE REPORT: We present the case of a 34 year old woman with chronic transvaginal bleeding since her last cesarean (five months ago), with histologic diagnosis of placental site trophoblastic tumor and inmuno- histoquimic report of choriocarcinoma, this early diagnosis improves her survival prognostic. CONCLUSION: placental site trophoblastic tumor and their evolution to choriocarcinoma have a low rate but it's possible. That it's the reason why complete diagnosis with biopsy, histologic and inmunohistoquimic report is mandatory to improve therapeutic.

[Tumor lysis syndrome in a pregnancy complicated with acute lymphoblastic leukemia]. / Síndrome de lisis tumoral en un embarazo complicado con leucemia linfoblástica aguda.

Acute leukemia is rare during pregnancy, affects about 1 in 75,000 pregnancies, of all leukemias diagnosed only 28% are acute lymphoblastic leukemia, this is a risk factor to develop spontaneous tumor lysis syndrome, it's a oncologic complication potentially deadly if the prophylactic treatment its avoided. Cases of acute lymphoblastic leukemia associated with pregnancy has been poorly documented in the literature the association of these two entities to pregnancy is the first report published worldwide, so the information is limited.

[Citohistologic and colposcopic correlation in perimenopausal women]. / Correlación histocitológica y colposcópica en pacientes en transición a la menopausia.

OBJECTIVE: This study was conducted to compare the correlation between the Pap smear and colposcopy findings in postmenopausal Mexican women. MATERIAL AND METHODS: Observational, Retroelective, longitudinal, descriptive study, all menopausal women who consulted for pap smears and colposcopy performed was studied. RESULTS: 119 patients were evaluated. 72 % of pap smears were negative to human papilloma virus, 29 (24%) had a low-grade lesion and 4 (4%) had a high-grade lesions. In the colposcopic study: 31 studies (26%) report low-grade intraepithelial lesion and 2 cases (2%) high-grade lesion. The histopathological biopsy reported one invasive cervical cancer (2.43%) and 20 cases of low-grade lesions (48.7%). cytology had a sensitivity of 85.3% and specificity of 56.09% with a false negative rate of 14.3%, a positive predictive value of 66.03 % and a negative predictive value of 79.31%. Colposcopy: sensitivity= 82.92%, specificity = 56.09% with a false negative rate of 17.07% positive predictive value of 65.38% and a negative predictive value of 76.66%. CONCLUSIONS: The correlation between Pap smear and colposcopy shows that the diagnosis of low and high grade lesions differs only by 2%, therefore indicates adequate sensitivity for diagnosis. In this population of women routine gynecological tests most be performed.

Estudio piloto en cuidadores de pacientes con enfermedades neurológicas, sobre el significado y conocimiento de cuidados paliativos / Estudo piloto em cuidadores de pacientes com enfermidades neurológicas, sobre o significado e conhecimento de cuidados paliativos / Pilot study with caregivers attending patients with neurologic diseases, about the meaning and knowledge of palliative care

Objetivo. Describir el significado que atribuyen cuidadores a los cuidados paliativos (CPS), así como su preferencia respecto a informar al paciente y su satisfacción con el papel de cuidador. Metodología. Estudio descriptivo transversal, muestra intencional de 40 cuidadores de enfermos neurológicos con necesidad de CPS. Se aplicó un cuestionario de conocimientos sobre el tema y sobrecarga. Se realizó análisis descriptivo-comparativo con un intervalo de confianza de 95 por ciento (p mayor 0.05). Resultados. Pacientes: 52,6 por ciento hombres, edad promedio de 57,9 por ciento años, tiempo de enfermedad: 5 años, 2 hijos en promedio. Cuidadores: 77,5 mujeres, 25,0 por ciento cónyuges. Edad promedio: 49.3 años, proporcionan 18,5 horas de cuidado diario, 62,5 por ciento tenía estudios de secundaria o superiores, 40 por ciento son cuidadores únicos, 16,7 por ciento no cuenta con redes de apoyo y 42,5 por ciento presenta sobrecarga alta. Un 70 por ciento no tenía información previa sobre CPS. Significado: 50 por ciento mencionó "dar ayuda" (física o emocional), 20 por ciento"mejorar la calidad de vida". El 87,5 por ciento desearía ser informado con detalle si ellos fueran los pacientes, 86,1 por ciento quisiera ser informado por el médico y 62,5 por ciento se mostró a favor de que se le informara con detalle a su familiar. Conclusiones. Es importante difundir los CPS en cuidadores y estimular el derecho de los pacientes a recibir información sobre el pronóstico de su enfermedad.

Aim. To describe the meaning attributed to palliative care (PC) by caregivers, as well as their preference with respect to informing the patient and their satisfaction in their caring role. Methodology: Study descriptive transversal, sample intended of 40 caregivers of neurologic patients needing PC. A questionnaire about knowledge of the topic and their burnout status was applied. A descriptive-comparative analysis was carried out with 95 percent (p higher 0.05) confidence interval. Results: Patients: 52.6 percent men, average age 57.9 years, duration of disease: 5 years, average of 2 children. Caregivers: 77.5 percent women, 25.0 percent married, average age: 49.3 years, daily caring 18.5 hours, 62.5 percent with high School or university studies, 40 percent alone as caregivers, 16.7 percent do not count with support nets and 42.5 percent present high burn out status. Of them 70 percent did not have previous information about PC. Meaning: 50 percent mentioned "to give help" (physical or emotional), 20 percent "to enhance quality of life". 87.5 percent would like to be informed with detail if they were the patients, 86.1 percent would like to be informed by the physician and 62.5 percent were in favor to inform with detail to their family member. Conclusions: It is important to disseminate PC to caregivers and to stimulate the right of patients to receive information about the prognosis of their disease.

Objetivo. Descrever o significado que atribuem cuidadores aos cuidados paliativos (CPS), assim como sua preferência com respeito a informar ao paciente e sua satisfação com o papel de cuidador. Metodologia. Estudo descritivo transversal, amostra intencional de 40 cuidadores de enfermos neurológicos com necessidade de CPS. Aplicou-se um questionário de conhecimentos sobre o tema e sobrecarga. Realizou-se análise descritivo-comparativa com um intervalo de confiança de 95 por cento (p superior 0.05). Resultados. Pacientes: 52,6 por cento homens, idade média de 57,9 anos, tempo de enfermidade: 5 anos, 2 filhos em média. Cuidadores: 77,5 por cento mulheres, 25,0 por cento cônjuges. Idade média: 49.3 anos, proporcionam 18,5 horas de cuidado diário, 62,5 por cento tinham estudos secundários ou superiores, 40 por cento são cuidadores únicos, 16,7 por cento não contam com redes de apoio e 42,5 por cento apresentam sobrecarga alta. 70 por cento não tinham informação prévia sobre CPS. Significado: 50 por cento mencionaram "dar ajuda" (física ou emocional), 20 por cento "melhorar a qualidade de vida". 87,5 por cento desejariam ser informados com detalhe se eles fossem pacientes, 86,1 por cento quiseram ser informados pelo médico e 62,5 por cento se mostraram a favor de que fossem informados com detalhes um seu familiar. Conclusões. É importante difundir os CPS em cuidadores e estimular o direito dos pacientes em receber informação sobre o prognóstico de sua enfermidade.

MLVA typing of Mycoplasma hyopneumoniae bacterins and field strains.

Because of the lack of information about both the genetic characteristics of Mycoplasma hyopneumoniae commercial vaccines and their relationship with field strains, the authors attempted to identify genetic subtypes of some M hyopneumoniae bacterins, and to compare them with M. hyopneumoniae field strains. Six commercial M hyopneumoniae bacterins and 28 bronchoalveolar lavages from pigs at slaughter from three herds were analysed by Multiple-Locus Variable number tandem repeat Analysis (MLVA) on p146R1, p146R3, H4, H5 and p95 loci. The results obtained showed the presence of more than one M hyopneumoniae genotype in some pigs and also in one of the bacterins analysed. It is also worth noting that MLVA typing allowed the distinction among circulating field strains and also when comparing them with vaccine strains, which, knowing the relatedness among them, could be useful in the research of the efficacy of the vaccines.

Liver preservation with machine perfusion and a newly developed cell-free oxygen carrier solution under subnormothermic conditions.

We describe a new preservation modality combining machine perfusion (MP) at subnormothermic conditions(21 °C) with a new hemoglobin-based oxygen carrier (HBOC) solution. MP (n=6) was compared to cold static preservation (CSP; n=6) in porcine orthotopic liver transplants after 9 h of cold ischemia and 5-day follow-up. Recipients' peripheral blood, serial liver biopsies, preservation solutions and bile specimens were collected before, during and after liver preservation. Clinical laboratorial and histological analyses were performed in addition to mitochondrial functional assays, transcriptomic, metabolomic and inflammatory inflammatory mediator analyses. Compared with CSP, MP animals had: (1) significantly higher survival (100%vs. 33%; p<0.05); (2) superior graft function (p<0.05);(3) eight times higher hepatic O2 delivery than O2 consumption (0.78 mL O2/g/h vs. 0.096 mL O2/g/h) during MP; and (4) significantly greater bile production (MP=378.5 ± 179.7; CS=151.6 ± 116.85). MP downregulated interferon (IFN)-α and IFN-γ in liver tissue. MP allografts cleared lactate, produced urea, sustained gluconeogenesis and produced hydrophilic bile after reperfusion. Enhanced oxygenation under subnormothermic conditions triggers regenerative and cell protective responses resulting in improved allograft function. MP at 21 °C with the HBOC solution significantly improves liver preservation compared to CSP.

Carbon dioxide capture utilizing zeolites synthesized with paper sludge and scrap-glass.

The present work introduces the study of the CO2 capture process by zeolites synthesized from paper sludge and scrap glass. Zeolites ZSM-5, analcime and wairakite were produced by means of two types of Structure Directing Agents (SDA): tetrapropilamonium (TPA) and ethanol. On the one hand, zeolite ZSM-5 was synthesized using TPA; on the other hand, analcime and wairakite were produced with ethanol. The temperature programmed desorption (TPD) technique was performed for determining the CO2 sorption capacity of these zeolites at two sorption temperatures: 50 and 100 °C. CO2 sorption capacity of zeolite ZSM-5 synthesized at 50 °C was 0.683 mmol/g representing 38.2% of the value measured for a zeolite ZSM-5 commercial. Zeolite analcime showed a higher CO2 sorption capacity (1.698 mmol/g) at 50 °C and its regeneration temperature was relatively low. Zeolites synthesized in this study can be used in the purification of biogas and this will produce energy without increasing the atmospheric CO2 concentrations.

Ortner's syndrome: a case report and review of the literature.

We present a case of a 67-year-old man who was an active smoker, with a clinical history of ischaemic cardiopathy, hypertension, who presented to the emergency room with hoarseness of voice of 2 weeks duration. No other neurological or cardiorespiratory symptoms were found. Physical examination revealed an aortic regurgitation murmur with radial pulse difference between the upper limbs and femoral pulse difference on lower limbs. Laryngoscopy examination revealed a left vocal cord paralysis in the paramedian position, without signs of malignancy. Thoracoabdominal CT angiography was performed to rule out an aortic dissection. CT revealed a dissection in the descending thoracic aortic arch and abdominal aorta. Cardiovascular surgery was consulted and decided to place endoprosthesis at the thoracic and abdominal aortic area. Hoarseness eventually resolved during the following weeks. Ortner's syndrome is described as hoarseness of voice caused by compression of the left recurrent laryngeal nerve of cardiovascular origin.

Multi-analytical assessment of iron and steel slag characteristics to estimate the removal of metalloids from contaminated water.

A multi-analytical approach was used to develop a mathematical regression model to calculate the residual concentration of borate ions in water present at high initial content, as a function of the main physicochemical, mineralogical and electrokinetic characteristics after adsorption on five different types of iron and steel slag. The analytical techniques applied and slag properties obtained in this work were: X-ray Fluorescence for the identification of the main chemical compounds, X-ray Diffraction to determine crystalline phases, physical adsorption of nitrogen for the quantification of textural properties and zeta-potential for electrokinetic measurements of slag particles. Adsorption tests were carried out using the bottle-point technique and a highly concentrated borate solution (700 mg B/L) at pH 10, with a slag dose of 10 g/L. An excellent correlation between the residual concentration of boron and three independent variables (content of magnesium oxide, zeta potential and specific surface area) was established for the five types of slag tested in this work. This shows that the methodology based on a multi-analytical approach is a very strong and useful tool to estimate the performance of iron and steel slag as adsorbent of metalloids.

Evaluation of copper slag to catalyze advanced oxidation processes for the removal of phenol in water.

The aim of this work was to evaluate the use of copper slag to catalyze phenol degradation in water by advanced oxidation processes (AOPs). Copper slag was tested in combination with H(2)O(2) (slag/H(2)O(2)) and H(2)O(2)/UV (slag/H(2)O(2)/UV). The studied methods promoted the complete photocatalytic degradation of phenol. Besides, they were able to reduce about 50% the TOC content in the samples. Slag/H(2)O(2)/UV and slag/H(2)O(2) treatments have favored biodegradability increment along the reaction time. Nevertheless, the irradiated method achieved higher values of the biodegradability indicator (BOD(5)/TOC). The toxicity assessment indicated the formation of more toxic compounds in both treatments. However, the control of the reaction time would minimize the environmental impact of the effluents.

Adiposity measures predict olfactory processing speed in older adult carriers of the apolipoprotein E ε4 allele.

OBJECTIVE: The current study investigated the relationship between adiposity and P3 latency. METHODS: Fifty-one adults in two age groups (18-25 and 65+) participated. Odor stimuli were delivered via olfactometer as participants focused on a computer screen. Each stimulus was followed by presentation on the screen of four odor identification choices. Participants attempted identification by button press. Olfactory event-related potentials (OERPs) were recorded. BMI and waist circumference were measured as indicators of adiposity. RESULTS: In bivariate analyses with all participants included, positive correlations for P3 latency with both BMI and waist circumference were observed, indicating that as adiposity increased latencies also increased. When each age group was separately examined, correlations between adiposity measures and latency remained statistically significant for older adults. Furthermore, ApoE ε4 allele status was examined. Latencies remained positively correlated with adiposity in older adult ε4 carriers; but not in non-carriers. CONCLUSIONS: This study indicates that adiposity predicts olfactory processing speed in older adults, specifically in ε4 carriers. SIGNIFICANCE: The results suggest that olfactory processing speed may be a useful measure for detecting and following the effects of adiposity on brain integrity and cognitive function in those at genetic risk for AD.