A cross-sectional study to evaluate utility measure and health-related quality of life (HRQoL) among patients with severe uncontrolled asthma in Spain.

BACKGROUND AND PURPOSE OF THE STUDY: The utility measure is a method to quantify health-related quality of life according to the preference values that patients attach to their health status. This study aimed to estimate the utility measure of patients with controlled and uncontrolled severe asthma (SA) in Spain, separately. Additionally, other characteristics (sociodemographic, clinical, and healthcare resource use [HCRU]) were also assessed for both SA populations. METHODS: This cross-sectional study included 159 patients with SA in Spain. Data were collected from medical records and directly from the patients during the study visit. Asthma Control Questionnaire (ACQ)-5 was used to classify patients with controlled and uncontrolled SA. RESULTS: Most of the patients were female (72.0% uncontrolled SA and 63.6% controlled SA). The mean (SD) EuroQol-5D (EQ-5D-5L) score was 0.88 (0.14) and 0.70 (0.25) in controlled and uncontrolled SA, respectively. The mean (SD) Asthma Quality-of-Life-5D (AQL-5D) score was 0.93 (0.09) and 0.85 (0.09) in controlled and uncontrolled SA, respectively. Emergency visits (19.2 vs. 2.7%) and hospitalizations (7.7% vs. no hospitalization) were more common among uncontrolled SA than controlled SA. Mean (SD) number of visits to primary care and pneumologists in uncontrolled SA vs. controlled SA was 4.1 (2.8) vs. 2.5 (3.0) and 3.7 (3.5) vs. 2.8 (2.2), respectively. CONCLUSION: The study provides data on utility measures among patients with SA in Spain for the first time. Patients with uncontrolled SA had lower HRQoL and higher HCRU than patients with controlled SA. Therefore, the implementation of measures that improve HRQoL among patients with uncontrolled SA is highly recommended.

Despite the existence in Spain of validated asthma questionnaires, the impact of severe asthma on quality of life, depending on whether it is controlled or not, had never been assessed.This study, which included 159 patients, was conducted to fill the gap above by obtaining two utility measures for quality of life, a generic one using the EQ-5D questionnaire (which can be used for comparison with other chronic conditions) and an asthma-specific one using the AQL-5D questionnaire.Patients with uncontrolled SA had a lower utility measure than patients with controlled disease and, therefore, a lower quality of life. In addition, patients with uncontrolled SA also had higher use of healthcare resources.These results highlight that the implementation of measures that improve the quality of life among patients with uncontrolled SA is highly recommended.

Examining the Effect of Ionizing Radiations in Ion-Exchange Membranes of Interest in Biomedical Applications.

The possible effects of ionizing radiation on four commercial membranes, which are typically used as electrolytes in fuel cells supplying energy to a huge variety of medical implantable devices, were studied. These devices could obtain energy from the biological environment through a glucose fuel cell, which could be a good candidate to replace conventional batteries as a power source. In these applications, materials with high radiation stability for the fuel cell elements would be disabled. The polymeric membrane is one of the key elements in fuel cells. Membrane swelling properties are very important because they affect the fuel cell's performance. For this reason, the swelling behaviors of various samples of each membrane irradiated with different doses were analyzed. Each sample was irradiated with a typical dose of a conventional radiotherapy treatment, and the regular conditions of the biological working environment were simulated. The target was to examine the possible effect of the received radiation on the membranes. The results show that the ionizing radiation influenced their swelling properties, as well as that dimensional changes were dependent on the existence of reinforcement, be it internal or external, in the membrane structure.

Prospective long-term experience in the treatment of renal tumors with cryotherapy: follow-up with computed tomography scan and contrast-enhanced ultrasound.

Introduction: The aim of this article was to evaluate the oncological results and safety of cryotherapy for the treatment of renal tumors. Material and methods: This study was a prospective review and follow-up of patients who underwent cryotherapy from January 2008 to May 2021. Cryotherapy was offered to patients with bilateral tumors, tumors in solitary kidneys, or comorbid patients. Follow-up consisted of a computed tomography (CT) scan and contrast-enhanced ultrasound (CEUS), with analysis of concordance (kappa index). Overall survival and kidney survival were analyzed (Kaplan-Meier). Results: Cryotherapy was performed 71 times in 67 patients. A total of 74.6% of patients were men. The mean age of patients was 69.7 years (standard deviation (SD) 11.3]. Mean follow-up was 52.7 months (SD 36.2). Mean tumor size was 26.2 mm (SD 7.6). 90% were cT1a, 10% cT1b stage. Type of access was open in 1 patient, laparoscopic in 8, percutaneous US-guided in 8 and percutaneous CT-guided in 54 patients. Biopsy was taken in 60 patients (84.5%) and consisted of renal cell carcinoma (22), oncocytoma (9), papillary carcinoma (4), angiomyolipoma (1), sarcoma (1), and non-conclusive (23).There were 22 complications such as pain in 2 patients, hematoma in 8 and 2 cases of bleeding, all resolved conservatively except for one case of bleeding which required embolization.Recurrences occurred in 16 cases (22.5%). Management was cryotherapy in 25%, radical nephrectomy in 31.3% and surveillance in 43.8%. Concordance between contrast-enhanced ultrasound and CT was 0.8 (excellent).Mean glomerular filtration did not change. One patient developed metastasis.No cancer-specific mortality was found. Overall survival at 12, 24 and 48 months was 98.5%, 96.8% and 76.9% respectively. Kidney survival at 12, 24 and 48 months was 97%, 93.5% and 93.5% respectively. Conclusions: Cryotherapy for renal tumors is a safe treatment for comorbid or solitary kidney patients, with rare major complications and good oncological outcome.

Identification of IL-6 Signalling Components as Predictors of Severity and Outcome in COVID-19.

IL-6 is one of the major mediators of the hyper-inflammatory responses with complex biological functions as it can signal via different modes of action. IL-6 by classical signalling has anti-inflammatory and antibacterial activities, while trans-signalling mediates pro-inflammatory effects. The net biological effect of IL-6 is established by multiple factors beyond its absolute concentration. Here, we assess the relationship between IL-6 signalling variables [IL-6, soluble IL-6R (sIL-6R) and soluble gp130 (sgp130)] and outcomes in a cohort of 366 COVID-19 patients. The potential trans-signalling was evaluated by a ratio between the pro-inflammatory binary IL-6:sIL-6R complex and the inactive ternary IL-6:sIL-6R:sgp130 complex (binary/ternary complex) and the fold molar excess of sgp130 over sIL-6R (FME). Our data provide new evidence that high levels of IL-6, sIL-6R, sgp130, binary/ternary complex ratio, and low FME are independent predictors of COVID-19 severity in survivor patients (without death), and the combination of IL-6 + sIL-6R + sgp130 exhibited the most robust classification capacity. Conversely, in a subgroup of patients with a very poor prognosis, we found that high levels of IL-6 and low levels of sIL-6R, sgp130, and binary/ternary complex ratio were predictors of death. In this context, the highest predictive capacity corresponded to the combined analysis of IL-6 + FME + lymphopenia + creatinine. Herein, we present IL-6 signalling variables as a helpful tool for the early identification and stratification of patients with clear implications for treatment and clinical decision-making.

Well-Leg Compartment Syndrome After Percutaneous Nephrolithotomy in the Galdakao-Modified Supine Valdivia Position.

PURPOSE: The objective is to present a case of well-leg compartment syndrome in the Galdakao-modified supine Valdivia position. RESULTS: The case of a 32-year-old male, obese (105 Kg) and a former smoker is presented. The patient was positioned in the Galdakao-modified supine Valdivia position, with lower limbs bandaged, to perform a right percutaneous nephrolithotomy. In the immediate postoperative period, significant pain was reported in the left lower limb. The limb appeared oedematous and cyanotic, although pedis pulses were preserved. Doppler ultrasound ruled out venous thrombosis. Suspecting compartment syndrome, the patient underwent a complete decompression fasciotomy of the four left leg compartments. After the surgery, values of creatine phosphokinase reached 80.000 UI/L and serum creatinine levels were 1.53 mg/dL. The patient was taken to the intensive care unit. Six months after the episode, the patient still needs rehabilitation care. The compartment syndrome is a rare complication in lithotomy position, but never described in the Galdakao-modified supine Valdivia position before, with the lower limbs in moderate flexion, and with the ipsilateral lower limb in a slightly inferior position with respect to the other. It may lead to skin necrosis, permanent neuromuscular dysfunction, myoglobinuric renal failure, amputation and even death. Therefore, this complication must be suspected and early decompression of the compartment must be performed. Risk factors include obesity, peripheral vascular disease (advanced age, hypertension, hyperlipidemia and diabetes mellitus), height, hypothermia, acidemia, BMI, male sex, combined general-spinal anesthesia, prolonged surgery time, systemic hypotension, ASA (American Society of Anesthesiologists) class, lack of operative experience, vasoconstricting drugs, important bleeding during the surgery and increased muscle bulk. CONCLUSION: Compartment syndrome is a potentially life-threatening complication that may occur in the Galdakao-modified supine Valdivia position. It should be suspected in cases with risk factors and compatible clinical symptoms and signs, and treated rapidly to avoid further complications.

Automatizing a nonscripting TPS for optimizing clinical workflow and reoptimizing IMRT/VMAT plans.

The purpose of this study was to design a toolkit that interacts with the Monaco (Elekta AB, Stockholm, Sweden) treatment planning system (TPS) for optimization of intensity-modulated radiation therapy and volumetric-modulated arc therapy without the need for a dedicated application programming interface. Successful inverse planning of radiotherapeutic treatment depends on the tweaking of many parameters; a tool was thus needed to explore these parameters more exhaustively without significantly increasing planning time. The software that we used was based on an open-source library that mimics human interaction with Microsoft Windows applications. We developed a simple Autoflow software routine that analyzes and optimizes calculated plans by considering the relative impact of different cost functions and modifying constraints accordingly. It was also designed to change segmentation parameters to fit more complex treatments. The toolkit is publicly available for download at https://bitbucket.org/hgugmradiofisica/pymonaco/src/master/. A study of prostate cancer cases was conducted to compare automatically created plans with previously treated cases. The toolkit fully automated the radiotherapy planning procedure, allowing the TPS to calculate or optimize plans during nonworking hours. In the prostate study, the use of this tool reduced the dose to organs at risk with a negligible decrease in target coverage. This tool enables the efficient use of the TPS, allowing research and clinical applications to coexist without conflict. It provides consistency and efficiency throughout the treatment planning process, which may be of great value to clinics with few resources. The impact of this tool on clinical workflow is important, as it not only provides better efficiency, but also increases treatment quality.

Creation of the SAQ-COPD Questionnaire to Determine Physical Activity in COPD Patients in Clinical Practice. / Creación del cuestionario SAQ-COPD (Spanish Physical Activity Questionnaire in COPD) para la medida de la actividad física de pacientes con EPOC en la práctica clínica.

INTRODUCTION: Physical activity (PA) is a significant clinical dimension in COPD, but no useful tools are available to determine this variable in routine clinical practice. OBJECTIVE: To create a simple, easy-to-use, specific questionnaire to detect PA deficits. METHOD: A multidisciplinary panel of COPD experts was formed to review PA, its determinants, and measuring methods. The methodology for selecting specific dimensions and items was agreed in rounds, and the aspects to be included in the preliminary version were determined. The questionnaire structure was defined according to applicability of these aspects in clinical practice. Agreements were reached by consensus of the members. RESULTS: A total of 148 items were reviewed, of which only 3 were directly selected. It was decided that the questionnaire should evaluate the intensity (low, moderate, or intense), amount, and frequency of PA, and inactivity or sedentary lifestyles. It also gathers information on the profile of inactive patients, and includes a measure of impact, defined as the patient's perception of their expectations regarding activity, their personal experience, characteristics of their environment, and their personality. The questionnaire is divided into 2blocks, one aimed at quantifying PA, and the other at collecting data for defining the profile and impact in patients with low PA only. CONCLUSION: The SAQ-COPD is a simple, short, specific questionnaire, designed to evaluate PA in COPD patients in clinical practice.

Estuarine sediment resuspension and acidification: Release behaviour of contaminants under different oxidation levels and acid sources.

Carbon dioxide (CO2) Capture and Storage (CCS) is a technology to reduce the emissions of this gas to the atmosphere by sequestering it in geological formations. In the case of offshore storage, unexpected CO2 leakages will acidify the marine environment. Reductions of the pH might be also caused by anthropogenic activities or natural events such as acid spills and dredging operations or storms and floods. Changes in the pH of the marine environment will trigger the mobilisation of elements trapped in contaminated shallow sediments with unclear redox boundary. Trace element (As, Cd, Cr, Cu, Ni, Pb and Zn) release from anoxic and oxic estuarine sediment is analysed and modelled under different laboratory acidification conditions using HNO3 (l) and CO2 (g): acidification at pH = 6.5 as worst-case scenario in events of CO2 leakages and acid spills, and acidification at pH = 7.0 as a seawater scenario under CO2 leakages, acid spills, as well as sediment resuspension. The prediction of metal leaching behaviour appear to require sediment specific and site specific tools. In the present work it is demonstrated that the proposed three in-series reactions model predicts the process kinetics of the studied elements under different simulated environmental conditions (oxidation levels and acid sources). Differences between HNO3 and CO2 acidification are analysed through the influence of the CO2 gas on the ionic competition of the medium. The acidification with CO2 provokes higher released concentrations from the oxic sediment than from the anoxic sediment, except in the case of Zn, which influences the release of the other studied elements. Slight acidification can endanger the aquatic environment through an important mobilisation of contaminants. The obtained prediction of the contaminant release from sediment (kinetic parameters and maximum concentrations) can contribute to the exposure assessment stage for risk management and preincidental planning in accidental CO2 leakages and chemical spills scenarios.

Prognosis of heart failure with preserved ejection fraction treated with ß-blockers: A propensity matched study in the community.

BACKGROUND: The effect of treatment with ß-blockers on the prognosis of patients newly diagnosed with heart failure with preserved ejection fraction (HFpEF) is unknown. OBJECTIVE: To analyze the relationship of commencing treatment with the ß-blockers bisoprolol or carvedilol (CT-ßB) with the prognosis of newly diagnosed HFpEF. METHODS: Prospective study over 10years on 2704 patients with HFpEF. Main outcomes were mortality (all-cause and cardiovascular), hospitalizations for HF worsening, and visits. The independent relationship between CT-ßB and the prognosis, stratifying patients for cardiovascular co-morbidity after propensity score-matching (985 patients CT-ßB vs. another 985 patients non-CT-ßB), was analyzed. RESULTS: During a median follow-up of 1877.4days (interquartile range, 1-3651.2) 1600 died (81.2%), and 1702 were hospitalized (86.4%). CT-ßB was associated with a lower risk of mortality (all-cause: HR [CI 95%] 0.78 [0.71 to 0.85], and cardiovascular: 0.75 [0.69 to 0.82]), a lower hospitalization rate (per 100 persons-year), 15.8 vs. 19.2, and a lower 30-day readmission rate (per 100 persons-year), 4.0 vs. 5.8, (P<0.001 in all cases), even after adjustment for the propensity to take ß-blockers or other medications, comorbidities, and other potential confounders. These effects of CT-ßB were independent of gender, and were observed in both patients taking high dose ßB (over the median dose) and lower dose ßB (under or equal to the median dose). CONCLUSIONS: In this propensity matched study, commencing treatment with bisoprolol or carvedilol, both at high and at lower doses, is associated with an improved prognosis of patients newly diagnosed with HFpEF.

Metal release from contaminated estuarine sediment under pH changes in the marine environment.

The contaminant release from estuarine sediment due to pH changes was investigated using a modified CEN/TS 14429 pH-dependence leaching test. The test is performed in the range of pH values of 0-14 using deionised water and seawater as leaching solutions. The experimental conditions mimic different circumstances of the marine environment due to the global acidification, carbon dioxide (CO2) leakages from carbon capture and sequestration technologies, and accidental chemical spills in seawater. Leaching test results using seawater as leaching solution show a better neutralisation capacity giving slightly lower metal leaching concentrations than when using deionised water. The contaminated sediment shows a low base-neutralisation capacity (BNCpH 12 = -0.44 eq/kg for deionised water and BNCpH 12 = -1.38 eq/kg for seawater) but a high acid-neutralisation capacity when using deionised water (ANCpH 4 = 3.58 eq/kg) and seawater (ANCpH 4 = 3.97 eq/kg). Experimental results are modelled with the Visual MINTEQ geochemical software to predict metal release from sediment using both leaching liquids. Surface adsorption to iron- and aluminium-(hydr)oxides was applied for all studied elements. The consideration of the metal-organic matter binding through the NICA-Donnan model and Stockholm Humic Model for lead and copper, respectively, improves the former metal release prediction. Modelled curves can be useful for the environmental impact assessment of seawater acidification due to its match with the experimental values.

Thromboprophylaxis with the low-molecular-weight heparin bemiparin sodium in elderly medical patients in usual clinical practice: the ANCIANOS study.

BACKGROUND: Venous thromboembolism (VTE) is a preventable common disease in geriatric medical patients, causing substantial morbidity and mortality. OBJECTIVE: To assess the effectiveness and safety of bemiparin sodium thromboprophylaxis in non-surgical elderly medical patients (aged > or =65 years) bedridden for at least 4 days due to acute medical illness. This was a prospective, observational, multicentre cohort study carried out in patients treated in the setting of geriatric centres (GCs) or hospital-at-home units (HHUs). The study included 507 non-surgical elderly patients recruited from 49 Spanish centres who were administered subcutaneous bemiparin sodium (Hibor) 2500 IU/day or 3500 IU/day, depending on the degree of VTE risk - moderate or high, respectively. Rates of VTE, major and minor bleeding events, thrombocytopenia and deaths that occurred during the 3-month study period were extracted. RESULTS: Seventy-two percent of the subjects were women, and the mean (SD) age was 82 (8) years. Overall, 70.6% (358 patients) were treated in GCs and 29.4% (149 patients) in HHUs. The main causes of immobilization were: heart failure (30.4%), acute infectious disease (29.8%), acute respiratory insufficiency (19.9%), rheumatological disease (i.e. osteoarthritis, rheumatoid arthritis and osteoporosis) [15.4%] and acute cerebrovascular disease (14.4%). Most of the patients (63%) had a high VTE risk and received the highest dose of prophylactic bemiparin sodium (3500 IU/day) for a mean 33 days. The incidence of VTE was 0.6% (three distal deep vein thromboses confirmed by Doppler ultrasound). No cases of pulmonary embolism were reported. There were two (0.4%) major bleeding events, eight (1.6%) minor bleeding events and seven (1.4%) cases of mild thrombocytopenia; no cases of moderate or severe thrombocytopenia were reported. Twenty-four patients (4.7%) developed mild to moderate injection site complications. Twenty-one patients (4.1%) died, but all from causes not related to study medication. CONCLUSIONS: Bemiparin sodium thromboprophylaxis for 4-5 weeks was associated with a low incidence of VTE and a low rate of bleeding and other complications in non-surgical elderly patients at risk of VTE, treated either in GCs or in HHUs, in standard clinical practice.