Decrease in Mortality after the Implementation of a Hospital Model to Improve Performance in Sepsis Care: Princess Sepsis Code.

Sepsis is a time-dependent disease whose prognosis is influenced by early diagnosis and therapeutic measures. Mortality from sepsis remains high, and for this reason, the guidelines of the Surviving Sepsis Campaign recommend establishing specific care programs aimed at patients with sepsis. We present the results of the application of a hospital model to improve performance in sepsis care, called Princess Sepsis Code, with the aim of reducing mortality. A retrospective study was conducted using clinical, epidemiological, and outcome variables in patients diagnosed with sepsis from 2015 to 2022. A total of 2676 patients were included, 32% of whom required admission to the intensive care unit, with the most frequent focus of the sepsis being abdominal. Mortality in 2015, at the beginning of the sepsis code program, was 24%, with a declining rate noted over the study period, with mortality reaching 17% in 2022. In the multivariate analysis, age > 70 years, respiratory rate > 22 rpm, deterioration in the level of consciousness, serum lactate > 2 mmol/L, creatinine > 1.6 mg/dL, and the focus of the sepsis were identified as variables independently related to mortality. The implementation of the Princess Sepsis Code care model reduces the mortality of patients exhibiting sepsis and septic shock.

Urinary Dickkopf-3: a new biomarker for CKD progression and mortality.

BACKGROUND: Kidney fibrosis has been reported to be a prognostic factor in chronic kidney disease (CKD) progression. Previous studies have shown that the assessment of urinary Dickkopf-3 (uDKK3), a stress-induced tubular epithelial-derived profibrotic glycoprotein, might be a potential tubulointerstitial fibrosis biomarker and might identify patients at short-term risk of glomerular filtration rate loss. We aim to evaluate uDKK3 as a potential biomarker for progression of CKD in a cohort with various aetiologies of CKD and subsequently in an overt diabetic nephropathy cohort. METHODS: We prospectively studied two independent cohorts comprising a total of 351 patients with Stages 2 and 3 CKD. Combined primary outcome consisted of a 50% increase in serum creatinine, end-stage kidney disease or death. The Progreser cohort included patients with heterogeneous aetiologies and the Pronedi cohort (101 patients) with overt diabetic nephropathy. The median follow-up time was 36 months [interquartile range (IQR) 30-39] and 36 (16-48), respectively. RESULTS: At baseline, median uDKK3 was 2200 pg/mg (IQR 671-7617) in the Progreser cohort and 3042 pg/mg (IQR 661-9747) in the Pronedi cohort. There were no statistically significant differences in the uDKK3 ratio between both cohorts nor between CKD aetiologies. Baseline uDKK3 was significantly higher in patients who reached the primary outcome. In the Cox proportional hazards model, the highest levels of uDKK3 were found to be an independent factor for renal progression in the Progreser cohort {hazard ratio [HR] 1.91 [95% confidence interval (CI) 1.04-3.52]} and in the Pronedi cohort [HR 3.03 (95% CI 1.03-8.92)]. uDKK3 gradually increased in the following months, especially in patients with higher proteinuria. Treatment with renin-angiotensin-aldosterone system blockers did not modify uDKK3 after 4 or 12 months of treatment. CONCLUSIONS: uDKK3 identifies patients at high risk of CKD progression regardless of the cause of kidney injury. uDKK3 might serve as a useful biomarker for kidney disease progression and therefore could be used by clinicians to optimize staging for renal progression and monitor the response to potential treatments.

Hydrogels based on waterborne poly(urethane-urea)s by physically cross-linking with sodium alginate and calcium chloride.

Waterborne poly(urethane-urea)s (WPUUs) can be employed as a base for the preparation of new materials with novel properties and applications, such as hydrogels. In this work, sodium alginate (SA) was incorporated into WPUUs and their nanocomposites with TiO2 nanoparticles. The influence of the addition of SA and TiO2 nanoparticles on the final properties of WPUUs based hydrogels was investigated. It was proven that the hydrogen bonding interactions that took place between WPUU and SA strongly affected the final properties. The glass transition temperature and thermal stability of investigated hydrogels were affected depending on the soft segment composition. The prepared hydrogels exhibited swelling ability in an acidic medium. The porous structure of the prepared hydrogels was confirmed by the scanning electron microscope (SEM) measurements. In fact, the mechanical properties indicated an improvement in the compressive modulus with the increase of the SA content. Furthermore, the prepared hydrogels allowed the cell proliferation of human fibroblasts.

Improvement of Mechanical Properties and Self-Healing Efficiency by Ex-Situ Incorporation of TiO2 Nanoparticles to a Waterborne Poly(Urethane-Urea).

This research work was focused on the incorporation of TiO2 nanoparticles into synthesized solvent-free waterborne poly(urethane-urea) (WPUU) based on hydrophilic poly(ethylene oxide) (PU0) in order to improve both the mechanical properties and self-healing effectiveness of a polymer matrix. The incorporation of TiO2 nanoparticles resulted in a successful enhancement of the mechanical properties of nanocomposite films when compared to PU0. Simultaneously, the obtained nanocomposite films did not only maintain the self-healing ability of the PU0 film, measured by means of mechanical properties after successive cutting/recovery cycles, but they also showed a higher self-healing efficiency than the PU0 film. Moreover, the well-dispersed TiO2 nanoparticles, visualized by atomic force microscopy (AFM), kept their conductive properties when embedded in the PU0 matrix, as was confirmed by electrostatic force microscopy (EFM). This research work described a simple and industrially appealing way to control the dispersion of commercially available TiO2 nanoparticles in waterborne poly(urethane-urea) for the designing of inorganic/organic hybrid nanocomposites with enhanced mechanical properties and self-healing efficiency, in which TiO2 nanoparticles preserved their conductive properties within the polymer matrix.

A novel pectin-degrading enzyme complex from Aspergillus sojae ATCC 20235 mutants.

BACKGROUND: In the food industry, the use of pectinase preparations with high pectin esterase (PE) activity leads to the release of methanol, which is strictly regulated in food products. Herein, a pectin-degrading enzyme (PDE) complex exhibiting low PE activity of three Aspergillus sojae ATCC 20235 mutants (M3, DH56 and Guserbiot 2.230) was investigated. Production of exo-/endo-polygalacturonase (PG), exo-polymethylgalacturonase (PMG) and pectin lyase (PL) by mutant M3 and A. sojae using two different carbon sources was evaluated in solid-state fermentation. Finally, experimental preparations obtained from the mutants and commercial pectinases standardized to the same potency were screened for PDEs. RESULTS: Mutant M3 grown on sugar beet was found to be the best producer of exo-PG, endo-PG, exo-PMG and PL, with maximum yields of 1111, 449, 130 and 123 U g(-1), respectively. All experimental preparations exhibited low PE activity, at least 21.5 times less than commercial pectinases, and higher endo-PG (40 U mL(-1)). CONCLUSION: Mutant M3 was the best PDE producer using sugar beet. Mutant strains presented a PDE complex featuring high endo-PG and very low PE activities. This novel complex with low de-esterifying activity can be exploited in the food industry to degrade pectin without releasing methanol.

Association between ongoing pain intensity, health-related quality of life, disability and quality of sleep in elderly people with total knee arthroplasty.

The scope of this paper was to study the relationship between pain intensity, health-related quality of life, disability, sleep quality and demographic data in elderly people with total knee arthroplasty (TKA). 24 subjects who had been subjected to TKA the previous month (4 females; 66 ± 9years) and 21 comparable controls (8 male; 70 ± 9years) participated in the study. Intensity of pain, and highest and lowest pain intensity experienced in the preceding week were collected. The Western Ontario and McMaster Universities index function, quality of life (Medical Outcomes Study Short Form 36), and Pittsburgh Sleep Quality Index were assessed. Age, gender, weight, height, body mass index were also collected. Individuals with TKA presented worse physical function (P < 0.01), social role (P = 0.01), physical performance (P < 0.01), pain (P = 0.04), disability (P = 0.04) and sleep quality (P = 0.03) than the controls. Higher intensity of pain was associated with lower physical function, social role, mental health, vitality and general health, and with higher disability and sleep quality. Disability and sleep quality were negatively associated with several quality of life domains. The associations between the intensity of pain, disability, quality of life and sleep reveal the multidimensional experience of TKA.

Association between ongoing pain intensity, health-related quality of life, disability and quality of sleep in elderly people with total knee arthroplasty / Associação entre a intensidade da dor, a qualidade de vida relacionada com a saúde, a incapacidade e a qualidade do sono em idosos com artroplastia total de joelho

The scope of this paper was to study the relationship between pain intensity, health-related quality of life, disability, sleep quality and demographic data in elderly people with total knee arthroplasty (TKA). 24 subjects who had been subjected to TKA the previous month (4 females; 66 ± 9years) and 21 comparable controls (8 male; 70 ± 9years) participated in the study. Intensity of pain, and highest and lowest pain intensity experienced in the preceding week were collected. The Western Ontario and McMaster Universities index function, quality of life (Medical Outcomes Study Short Form 36), and Pittsburgh Sleep Quality Index were assessed. Age, gender, weight, height, body mass index were also collected. Individuals with TKA presented worse physical function (P < 0.01), social role (P = 0.01), physical performance (P < 0.01), pain (P = 0.04), disability (P = 0.04) and sleep quality (P = 0.03) than the controls. Higher intensity of pain was associated with lower physical function, social role, mental health, vitality and general health, and with higher disability and sleep quality. Disability and sleep quality were negatively associated with several quality of life domains. The associations between the intensity of pain, disability, quality of life and sleep reveal the multidimensional experience of TKA.

Objetivo: Identificar as relações entre intensidade da dor, qualidade de vida relacionada à saúde, incapacidade, qualidade do sono e dados demográficos em idosos com artroplastia total de joelho (ATJ). Métodos: Participaram vinte e quatro pacientes que receberam ATJ no mês anterior (4 mulheres; 66 ± 9 anos) e 21 controles comparáveis (8 homens; 70 ± 9 anos). Foram coletadas a intensidade da dor no momento da avaliação, a maior e a menor intensidade de dor sentida na semana anterior. A função (Western Ontario and McMaster Universities index), a qualidade de vida (Medical Outcomes Study Short Form 36), e a qualidade do sono (Pittsburgh Sleep Quality Index) foram avaliadas. Idade, sexo, peso, altura, índice de massa corporal também foram coletados. Resultados: Indivíduos com ATJ mostraram pior função física (P < 0,01), papel social (P = 0,01), desempenho físico (P < 0,01), dor (P = 0,04), incapacidade (P = 0,04) e qualidade do sono (P = 0,03) do que os controles. Maior intensidade da dor foi associada com menor função física, papel social, saúde mental, vitalidade e saúde geral, e com maior incapacidade e qualidade do sono. Incapacidade e qualidade do sono estiveram associa das negativamente com vários domínios de qualidade de vida. As associações entre a intensidade da dor, incapacidade, qualidade de vida e do sono mostram a experiência multidimensional da ATJ.

Synthesis of unsymmetrical carboxyphthalocyanines by palladium-catalyzed hydroxycarbonylation of iodo-substituted precursors.

Phthalocyanines (Pcs) containing a carboxylic acid functionality directly bound to the macrocycle have been synthesized, in one step and in good yields, from iodo-substituted Pc precursors. This methodology represents a convenient alternative to the commonly used method based on two consecutive oxidations of hydroxymethyl Pcs.

Structural and dynamical patterns on online social networks: the Spanish May 15th movement as a case study.

The number of people using online social networks in their everyday life is continuously growing at a pace never saw before. This new kind of communication has an enormous impact on opinions, cultural trends, information spreading and even in the commercial success of new products. More importantly, social online networks have revealed as a fundamental organizing mechanism in recent country-wide social movements. In this paper, we provide a quantitative analysis of the structural and dynamical patterns emerging from the activity of an online social network around the ongoing May 15th (15M) movement in Spain. Our network is made up by users that exchanged tweets in a time period of one month, which includes the birth and stabilization of the 15M movement. We characterize in depth the growth of such dynamical network and find that it is scale-free with communities at the mesoscale. We also find that its dynamics exhibits typical features of critical systems such as robustness and power-law distributions for several quantities. Remarkably, we report that the patterns characterizing the spreading dynamics are asymmetric, giving rise to a clear distinction between information sources and sinks. Our study represents a first step towards the use of data from online social media to comprehend modern societal dynamics.

[Idiopathic hypertrophic cranial pachymeningitis diagnosed after venous thrombosis]. / Paquimeningitis hipertrófica craneal idiopática diagnosticada tras trombosis venosa.

INTRODUCTION: Idiopathic hypertrophic cranial pachymeningitis (IHCP) is a rare and little known form of chronic inflammation of the dura mater, the pathogenesis of which remains unclear. CASE REPORT: We report the case of a 77-year-old male who was admitted to hospital after suffering a stroke; following the findings in the MR imaging, the patient was diagnosed as having IHCP. Treatment with corticoids led to an improvement in the patient's condition both clinically and radiologically. CONCLUSIONS: IHCP produces a non-nodular diffuse dural thickening that is hypointense with respect to the brain parenchyma in all the MRI sequences with intravenous contrast enhancement.