Impact of a pulmonary embolism response team (PERT) in the prognosis of patients with acute symptomatic pulmonary embolism.

BACKGROUND: The effect of a pulmonary embolism response team (PERT) in the short-term prognosis of patients with acute symptomatic pulmonary embolism (PE) lacks clarity. We therefore aimed at evaluating the effect of a PERT team on short-term mortality among patients with acute PE. METHODS: We retrospectively reviewed consecutive patients with acute symptomatic PE enrolled in a single-center registry between 2007 and 2022. We used propensity score matching to compare treatment effects for patients with similar predicted probabilities of receiving management by the PERT team. The primary outcome was all-cause mortality within 30 days following the diagnosis of PE. The secondary outcome was 30-day PE-related mortality. RESULTS: Of the 2,902 eligible patients who had acute symptomatic PE, 223 (7.7%; 95% confidence interval [CI], 6.7%-8.7%) were managed by the PERT team. Two hundred and seven patients who were treated by the PERT were matched with 207 patients who were not. Matched pairs did not show a statistically significant lower all-cause (odds ratio [OR], 1.09; 95% CI, 0.63-1.89) or PE-related death (OR, 1.30; 95% CI, 0.47-3.62) for PERT management compared with no PERT management through 30 days after diagnosis of PE. CONCLUSIONS: Our results suggest that multidisciplinary care of patients with acute symptomatic PE by a PERT team is not associated with a significant reduction in short-term all-cause or PE-related mortality.

[Pulmonary rehabilitation effects in patients with COPD according to GOLD 2020 classification in Cali, Colombia]. / Efectos de la rehabilitación pulmonar en pacientes con EPOC según la clasificación GOLD 2020 en Cali, Colombia.

INTRODUCTION: Chronic obstructive pulmonary disease has a guide in charge of prevention and treatment, called the Global Initiative for Chronic Lung Disease, which is annually updated and catalogs pulmonary rehabilitation, within the treatment options. OBJECTIVE: To describe the effects on clinical variables, functional capacity, anxiety/depression and health-related quality of life in patients with chronic obstructive pulmonary disease, after a pulmonary rehabilitation program, according to the GOLD 2020 classification in a Cali clinic. MATERIALS AND METHODS: Descriptive, longitudinal study where 79 patients divided into 3 groups were included (B, C and D). RESULTS: The mean age was 70 years, 69% men. The number of hospitalized days was greater for groups C and D with an average of 8 and 13 days, respectively (p≤0.000). The functional capacity showed a greater distance in group C (421m) and the shortest distance for group D (328m), p≤0.006. In anxiety and depression, group D managed to obtain improvements as well as in the quality of life questionnaire. CONCLUSION: Group C presented greater functional capacity and better quality of life, group B had better results in clinical variables, and group D had worse clinical condition, functional capacity and quality of life. At the end of pulmonary rehabilitation, group D presented greater changes in functional capacity and quality of life.

Reconfigurable frequency multipliers based on graphene field-effect transistors.

Run-time device-level reconfigurability has the potential to boost the performance and functionality of numerous circuits beyond the limits imposed by the integration density. The key ingredient for the implementation of reconfigurable electronics lies in ambipolarity, which is easily accessible in a substantial number of two-dimensional materials, either by contact engineering or architecture device-level design. In this work, we showcase graphene as an optimal solution to implement high-frequency reconfigurable electronics. We propose and analyze a split-gate graphene field-effect transistor, demonstrating its capability to perform as a dynamically tunable frequency multiplier. The study is based on a physically based numerical simulator validated and tested against experiments. The proposed architecture is evaluated in terms of its performance as a tunable frequency multiplier, able to switch between doubler, tripler or quadrupler operation modes. Different material and device parameters are analyzed, and their impact is assessed in terms of the reconfigurable graphene frequency multiplier performance.

Two predicted α-helices within the prion-like domain of TIAR-1 play a crucial role in its association with stress granules in Caenorhabditis elegans.

Stress granules (SGs) are sites for mRNA storage, protection, and translation repression. TIA1 and TIAR1 are two RNA-binding proteins that are key players in SGs formation in mammals. TIA1/TIAR have a prion-like domain (PrD) in their C-terminal that promotes liquid-phase separation. Lack of any TIA1/TIAR has severe consequences in mice. However, it is not clear whether the failure to form proper SGs is the cause of any of these problems. We disrupted two predicted α-helices within the prion-like domain of the Caenohabditis elegans TIA1/TIAR homolog, TIAR-1, to test whether its association with SGs is important for the nematode. We found that tiar-1 PrD mutant animals continued to form TIAR-1 condensates under stress in the C. elegans gonad. Nonetheless, TIAR-1 condensates appeared fragile and disassembled quickly after stress. Apparently, the SGs continued to associate regularly as observed with CGH-1, an SG marker. Like tiar-1-knockout nematodes, tiar-1 PrD mutant animals exhibited fertility problems and a shorter lifespan. Notwithstanding this, tiar-1 PrD mutant nematodes were no sensitive to stress. Our data demonstrate that the predicted prion-like domain of TIAR-1 is important for its association with stress granules. Moreover, this domain may also play a significant role in various TIAR-1 functions unrelated to stress, such as fertility, embryogenesis and lifespan.

Usefulness of bilateral mucoplasty plus reboot surgery in severe type-2 chronic rhinosinusitis with nasal polyps.

BACKGROUND: Although extended endoscopic sinus surgery (ESS) constitutes an alternative approach in patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), the surgical techniques proposed so far do not allow for an optimal control of the disease. This study introduces bilateral mucoplasty as a complementary technique to extended ESS such as reboot surgery, analyzing its benefits in healing and quality of life (QoL). METHODS: Patients diagnosed with severe Type-2 CRSwNP were selected for a prospective cohort study in two surgery groups: reboot surgery plus bilateral mucoplasty versus reboot surgery only. In the first group, an autologous endonasal mucosal graft from the nostril floor was placed bilaterally onto the ethmoidal roof. Endoscopic, radiological and QoL outcomes were compared before and one year after surgery between the two groups using Modified Lund Kennedy (LKM), Meltzer and Lund Mackay (LM) scores, and the Sino-Nasal Outcome Test 22 (SNOT-22). RESULTS: 64 patients with homogeneous baseline characteristics were included: 17 patients underwent a reboot surgery plus a bilateral mucoplasty and 47 a reboot surgery only. LKM, Meltzer and SNOT-22 scores showed significant differences before and after surgery in both groups, with higher improvement in the mucoplasty group. A greater mean improvement of 20.5 ± 6.4 points in SNOT-22 change was associated with bilateral mucoplasty. CONCLUSION: Bilateral mucoplasty plus reboot surgery constitutes a useful surgical resource in Type-2 CRSwNP patients, showing improved endoscopic, radiological and QoL outcomes one year after surgery. Further studies are needed to determine their long-term benefits.

An insight into an intriguing oxidative biotransformation pathway of 5-O-caffeoylquinic acid by a gut bacterium.

Microbiota is known to play a pivotal role in generating bioavailable and bioactive low-molecular-weight metabolites from dietary polyphenols. 5-O-caffeoylquinic acid (5-CQA), one of the main polyphenols found in human diet, was submitted to a resting cell biotransformation study using three gut bacteria species Lactobacillus reuteri, Bacteroides fragilis and Bifidobacterium longum. These bacteria were selected according to their belonging to the main phyla found in human gut microbiota. Our study highlighted the ability of only one of the strains studied, L. reuteri, to bioconverse 5-CQA into various metabolites due to the expression of the cinnamoyl esterase enzyme as the first step. Interestingly, one known natural compound, esculetin, was described for the first time as a 5-CQA-derived metabolite after conversion by a gut bacterium, the other metabolites had already been reported. This evidence highlighted an interesting oxidative pathway occurring in vivo by intestinal microbiota leading to esculetin. This molecule was also identified after electrochemical and enzymatic oxidations of caffeic acid. The oxidation capacity of L. reuteri led to less diverse metabolites in comparison to those obtained either electrochemically and enzymatically where dimers and trimers were reported. Thus, esculetin may have interesting and benefical biological effects on gut microbiota, which should be further evaluated. Novel synbiotics could be formulated from the association of L. reuteri with 5-CQA.

Changes in Body Composition in Older Adults after a Technology-Based Weight Loss Intervention.

We conducted a post-hoc analysis of a pre/post, single-arm, non-randomized, multicomponent weight loss intervention in older adults. Fifty-three older adults aged ≥65 with a body mass index ≥ 30 kg/m2 were recruited to participate in a six-month, remote monitoring and video-conferencing delivered, prescriptive intervention consisting of individual and group-led registered dietitian nutrition and physical therapy sessions. We assessed weight, height, and body composition using a SECA 514 bioelectrical impedance analyzer. Mean age was 72.9±3.9 years (70% female) and all had ≥2 chronic conditions. Of those with complete data (n=30), we observed a 4.6±3.5kg loss in weight, 6.1±14.3kg (1.9%) loss in fat mass, and 0.78±1.69L loss in visceral fat (all p<0.05). Fat-free mass (-3.4kg±6.8, p=0.19), appendicular lean mass (-0.25±1.83, p=0.22), and grip strength (+3.46±7.89, p=0.56) did not significantly change. These variables were preserved after stratifying by 5% weight loss. Our intervention led to significant body and visceral fat loss while maintaining fat-free and appendicular lean muscle mass.

Impact of the implementation of a Sepsis Code Program in medical patient management: a cohort study in an Internal Medicine ward.

OBJECTIVE: Sepsis is the main cause of death in hospitals and the implementation of diagnosis and treatment bundles has shown to improve its evolution. However, there is a lack of evidence about patients attended in conventional units. METHODS: A 3-year retrospective cohort study was conducted. Patients hospitalized in Internal Medicine units with sepsis were included and assigned to two cohorts according to Sepsis Code (SC) activation (group A) or not (B). Baseline and evolution variables were collected. RESULTS: A total of 653 patients were included. In 296 cases SC was activated. Mean age was 81.43 years, median Charlson comorbidity index (CCI) was 2 and 63.25% showed some functional disability. More bundles were completed in group A: blood cultures 95.2% vs 72.5% (p <0.001), extended spectrum antibiotics 59.1% vs 41.4% (p < 0.001), fluid resuscitation 96.62% vs 80.95% (p < 0.001). Infection control at 72 hours was quite higher in group A (81.42% vs 55.18%, odds ratio 3.55 [2.48-5.09]). Antibiotic was optimized more frequently in group A (60.77% vs 47.03%, p 0.008). Mean in-hospital stay was 10.63 days (11.44 vs 8.53 days, p < 0.001). Complications during hospitalization appeared in 51.76% of patients, especially in group B (45.95% vs 56.58%, odds ratio 1.53 [1.12-2.09]). Hospital readmissions were higher in group A (40% vs 24.76%, p < 0.001). 28-day mortality was significantly lower in group A (20.95% vs 42.86%, odds ratio 0.33 [0.23-0.47]). CONCLUSIONS: Implementation of SC seems to be effective in improving short-term outcomes in IM patients, although therapy should be tailored in an individual basis.

Understanding patient-reported knowledge of hernia surgery: a quantitative study.

PURPOSE: The objective of this study was to gather information on patient-reported knowledge (PRK) in the field of hernia surgery. METHODS: A prospective quantitative study was designed to explore different aspects of PRK and opinions regarding hernia surgery. Patients referred for the first time to a surgical service with a presumed diagnosis of hernia and eventual hernia repair were eligible, and those who gave consent completed a simple self-assessment questionnaire before the clinical visit. RESULTS: The study population included 449 patients (72.8% men, mean age 61.5). Twenty (4.5%) patients did not have hernia on physical examination. The patient's perceived health status was "neither bad nor good" or "good" in 56.6% of cases. Also, more patients considered that hernia repair would be an easy procedure (35.1%) rather than a difficult one (9.8%). Although patients were referred by their family physicians, 32 (7.1%) answered negatively to the question of coming to the visit to assess the presence of a hernia. The most important reason of the medical visit was to receive medical advice (77.7%), to be operated on as soon as possible (40.1%) or to be included in the surgical waiting list (35.9%). Also, 46.1% of the patients considered that they should undergo a hernia repair and 56.8% that surgery will be a definitive solution. CONCLUSION: PRK of patients referred for the first time to an abdominal wall surgery unit with a presumed diagnosis of hernia was quite limited and there is still a long way towards improving knowledge of hernia surgery.

[Sepsis Code: dodging mortality in a tertiary hospital]. / Código Sepsis: esquivando la mortalidad en un hospital terciario.

OBJECTIVE: In the hospital of La Princesa, the "Sepsis Code" (CSP) began in 2015, as a multidisciplinary group that provides health personnel with clinical, analytical and organizational tools, with the aim of the detection and early treatment of patients with sepsis. The objective of this study is to evaluate the impact of CSP implantation on mortality and to determine the variables associated with an increase in it. METHODS: A retrospective analytical study of patients with CSP alert activation from 2015 to 2018 was conducted. Clinical-epidemiological variables, analytical parameters, and severity factors such as admission to critical care units (UCC) and the need for amines were collected. Statistical significance was established at p < 0.05. RESULTS: We included 1,121 patients. The length of stay was 16 days and 32% required admission to UCC. Mortality showed a statistically significant linear downward trend from 24% in 2015 to 15% in 2018. The predictive mortality variables with statistically significant association were lactate > 2 mmol/L, creatinine > 1.6 mg/dL and the need for amines.>5.0%, mortality at the time of chart review 62.0%, and 6-months-post-discharge readmission 47.7%. CONCLUSIONS: The implementation of Sepsis Code decreases the mortality of patients with sepsis and septic shock. The presence of a lactate > 2 mmol/L, creatinine > 1.6 mg/dL and/or the need to administer amines in the first 24 hours, are associated with an increase in mortality in the patient with sepsis.

Prioritization criteria of patients on scheduled waiting lists for abdominal wall hernia surgery: a cross-sectional study.

PURPOSE: Long delays in waiting lists have a negative impact on the principles of equity and providing timely access to care. This study aimed to assess waiting lists for abdominal wall hernia repair (incisional ventral vs. inguinal hernia) to define explicit prioritization criteria. METHODS: A cross-sectional single-center study was designed. Patients in the waiting list for incisional/ventral hernia (n = 42) and inguinal hernia (n = 50) repair were interviewed by phone and completed health-related quality of life (HRQoL) questionnaires (EQ-5D, COMI-hernia, HerQLes) as a measure of severity. Priority was measured as hernia complexity, patient frailty using the modified frailty index (mFI-11), and the consumption of analgesics for hernia. RESULTS: The mean (SD) time on the waiting list was 5.5 (3.2) months (range 1-14). Complex hernia was present in 34.8% of the patients. HRQoL was moderately poor in patients with incisional/ventral hernia (mean HerQL score 66.1), whereas it was moderately good in patients with inguinal hernia (mean COMI-hernia score 3.40). The use of analgesics was higher in patients with incisional/ventral hernia as compared with those with inguinal hernia (1.48 [0.54] vs. 1.31 [0.51], P = 0.021). Worst values of mFI were associated with inguinal hernia as compared with incisional/ventral hernia (0.21 [0.14] vs. 0.12 [0.11]; P = 0.010). CONCLUSION: Explicit criteria for prioritization in the waiting lists may be the consumption of analgesics for patients with incisional/ventral hernia and frailty for patients with inguinal hernia. A reasonable approach seems to establish separate waiting lists for incisional/ventral hernia and inguinal hernia repair.

Multi-scale analysis of radio-frequency performance of 2D-material based field-effect transistors.

Two-dimensional materials (2DMs) are a promising alternative to complement and upgrade high-frequency electronics. However, in order to boost their adoption, the availability of numerical tools and physically-based models able to support the experimental activities and to provide them with useful guidelines becomes essential. In this context, we propose a theoretical approach that combines numerical simulations and small-signal modeling to analyze 2DM-based FETs for radio-frequency applications. This multi-scale scheme takes into account non-idealities, such as interface traps, carrier velocity saturation, or short channel effects, by means of self-consistent physics-based numerical calculations that later feed the circuit level via a small-signal model based on the dynamic intrinsic capacitances of the device. At the circuit stage, the possibilities range from the evaluation of the performance of a single device to the design of complex circuits combining multiple transistors. In this work, we validate our scheme against experimental results and exemplify its use and capability assessing the impact of the channel scaling on the performance of MoS2-based FETs targeting RF applications.

Atención a mujeres en situación de aborto en el Hospital San José (2016-2019) / Attention to woman in abortion situation at San José Hospital (2016-2019)

Objetivo: evaluar la incorporación de elementos de calidad de atención a mujeres en situación de aborto (MSA) en la Unidad de Salud Sexual y Salud Reproductiva del Hospital San José, entre 2016 y 2019. Métodos: utilizando los datos recabados en el Sistema Informático Perinatal (SIP), se realizó un análisis descriptivo de las características sociodemográficas y se evaluó la implementación de la Unidad de Salud Sexual y Reproductiva a través de indicadores de atención de calidad. Resultados: las variables sociodemográficas que caracterizan nuestra población están definidas por una alta proporción de mujeres extranjeras (44,5%), que cuentan con un nivel educacional medio (63,8% educación secundaria y 26% universitaria), y una alta proporción de necesidades insatisfechas de métodos anticonceptivos (70,3%), representando características sociodemográficas similares a los diferentes centros de salud pública de la región. La tendencia de los indicadores de calidad de atención en las mujeres en situación de aborto del Hospital San José mejoró posterior a la implementación de la Unidad de Salud Sexual y Reproductiva y el modelo de atención postaborto (APA) al disminuir los métodos de evacuación uterina no recomendados y aumentar la cobertura en anticoncepción inmediata postaborto. Conclusión: la implementación de una unidad especializada en salud sexual y reproductiva mejora los indicadores de calidad a la MSA. (AU)

Objective: to evaluate the incorporation of elements of quality of care for women in abortion situation (WAS) in the Sexual Health and Reproductive Health Unit of the San José Hospital, between 2016 and 2019. Methods: using the data collected in the Perinatal Information System (SIP), a descriptive analysis of the sociodemographic characteristics was carried out and the implementation of the Sexual and Reproductive Health Unit was evaluated through quality care indicators. Results: the sociodemographic variables that characterize our population are defined by a high proportion of foreign women (44.5%), who have a medium educational level (63.8% secondary education and 26% university), and a high proportion of unmet needs for contraceptive methods (70.3%), representing sociodemographic characteristics similar to the different public health centers in the region. The trend of the quality of care indicators for women in abortion at the San José Hospital improved after the implementation of the Sexual and Reproductive Health Unit and the postabortion care model (PAC) by reducing non- recommended uterine evacuation methods. and increase coverage in immediate postabortion contraception. Conclusion: the implementation of a specialized unit in sexual and reproductive health improves the quality indicators of the WSA. (AU)

Spontaneus subscapular abscess. A clinical case.

Infections of the subscapular space are very infrequent entities, which is why their diagnosis (for which it is crucial to carry out magnetic resonance imaging or, failing that, computerized tomography) can prove complicated. This difficulty in making the diagnosis conditions the speed of treatment (surgical draining that can be accompanied by antibiotherapy), which is crucial for the medium and long-term prognosis. We present the case of a patient who developed a spontaneous subscapular abscess that was drained using a delto-pectoral approach, with the subscapular space accessed via a medial route to the coracoids. The relevance of this case lies in its singular character and in the description of an approach that has only been used in two prior cases in the literature.

Effects of Climate Variability on Queen Production and Pollen Preferences of Neotropical Bumblebee Bombus atratus in a High Andean Suburban Condition.

Bombus atratus Franklin is a widely distributed bumblebee of South America. In Colombia, this species is recognized for its ability to adapt to highly disturbed habitats. However, knowledge of its ecology is poorly known, in particular conditions to ensure the long-term conservation of its populations. Identification of pollen resources is an important issue that could be used as a tool to manage and conserve bumblebees. In tropical areas, rainfall patterns could affect floral phenology and therefore the availability of pollen resources. Considering this, the present work aimed to establish the effect of extreme weather conditions (El Niño) in pollen availability, use of pollinic sources, and gyne production in B. atratus colonies. We reared and located 14 B. atratus colonies in a suburban area during a dry season (ENSO "El Niño") and a rainy season (ENSO "La Niña"). We registered time to gyne production and numbers of gynes produced per colony. We extracted pollen samples to establish both its floral origin and its relative abundance. We measured floral offer for each season. The data of pollen use per colony were utilized to perform Bipartite networks. We analyzed the production of gynes and pollen use per season with correlation models and generalized linear models. Colonies of the rainy season produced more gynes and faster. The floral diversity and offer were higher during the rainy season. Successful colonies used specific pollen sources in two seasons, independently of the floral offer. Extreme dry season affected development of B. atratus colonies.

Tuning porosity in macroscopic monolithic metal-organic frameworks for exceptional natural gas storage.

Widespread access to greener energy is required in order to mitigate the effects of climate change. A significant barrier to cleaner natural gas usage lies in the safety/efficiency limitations of storage technology. Despite highly porous metal-organic frameworks (MOFs) demonstrating record-breaking gas-storage capacities, their conventionally powdered morphology renders them non-viable. Traditional powder shaping utilising high pressure or chemical binders collapses porosity or creates low-density structures with reduced volumetric adsorption capacity. Here, we report the engineering of one of the most stable MOFs, Zr-UiO-66, without applying pressure or binders. The process yields centimetre-sized monoliths, displaying high microporosity and bulk density. We report the inclusion of variable, narrow mesopore volumes to the monoliths' macrostructure and use this to optimise the pore-size distribution for gas uptake. The optimised mixed meso/microporous monoliths demonstrate Type II adsorption isotherms to achieve benchmark volumetric working capacities for methane and carbon dioxide. This represents a critical advance in the design of air-stable, conformed MOFs for commercial gas storage.