Influence of molecular parameters on the representativeness of interfacial properties of simple fluids.

New parameterizations for the Lennard-Jones 12/6 potential capable of reproducing the vapor pressure and surface tension with sufficient precision, but not the liquid-vapor equilibrium densities for the case of simple fluids that include Ar, Kr, Xe, Ne, and CH4 are presented in this work. These results are compared with those derived from the family of Mie(n, 6) potentials, which adequately reproduce the coexistence curve and the vapor pressure, leaving aside the surface tension. In addition, a detailed analysis is presented on different parameterizations and methodologies, which have been developed in recent decades to estimate the interfacial properties of interest here for simple fluids, such as argon, which is a molecule that is, in principle, "simple" to study but that clearly reveals the enormous discrepancy between the results reported in the literature throughout these years. These facts undoubtedly reveal one of the fundamental problems in the context of molecular thermodynamics of fluids: reproducing different thermodynamic properties with sufficient precision from a single set of free parameters for some interaction potential. In order to show the scope of the parameterizations presented for the Lennard-Jones model, they were successfully applied to the case of binary mixtures, which included Ar-Kr, Ar-CH4, and Xe-Kr. Finally, and with the aim of showing a possible solution to the problem posed in this research, results of the same interfacial properties above mentioned for argon and methane were presented in this work by using a set of molecular interactions, called ANC2s, whose flexibility allowed to reproduce the experimental evidence with just one parameterization. The results reported in this work were generated using molecular dynamics simulations.

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.

Characterization of a furan aldehyde-tolerant ß-xylosidase/α-arabinosidase obtained through a synthetic metagenomics approach.

AIMS: The aim of the study was to characterize 10 hemicellulolytic enzymes obtained from a wheat straw-degrading microbial consortium. METHODS AND RESULTS: Based on previous metagenomics analyses, 10 glycosyl hydrolases were selected, codon-optimized, synthetized, cloned and expressed in Escherichia coli. Nine of the overexpressed recombinant proteins accumulated in cellular inclusion bodies, whereas one, a 37·5-kDa protein encoded by gene xylM1989, was found in the soluble fractions. The resulting protein, denoted XylM1989, showed ß-xylosidase and α-arabinosidase activities. It fell in the GH43 family and resembled a Sphingobacterium sp. protein. The XylM1989 showed optimum activity at 20°C and pH 8·0. Interestingly, it kept approximately 80% of its ß-xylosidase activity in the presence of 0·5% (w/v) furfural and 0·1% (w/v) 5-hydroxymethylfurfural. Additionally, the presence of Ca2+ , Mg2+ and Mn2+ ions increased the enzymatic activity and conferred complete tolerance to 500 mmol l-1 of xylose. Protein XylM1989 is also able to release sugars from complex polysaccharides. CONCLUSION: We report the characterization of a novel bifunctional hemicellulolytic enzyme obtained through a targeted synthetic metagenomics approach. SIGNIFICANCE AND IMPACT OF THE STUDY: The properties of XylM1989 turn this protein into a promising enzyme that could be useful for the efficient saccharification of plant biomass.

Epidemiological surveillance in dairy farms in the Pastaza province of Ecuador. / Vigilancia epidemiológica en predios lecheros de la provincia de Pastaza, Ecuador.

A survey was carried out on dairy cattle farms in Pastaza province to analyse the degree of compliance with epidemiological surveillance activities (based on the main technical aspects in Ecuador's Guide to Good Dairy Farming Practices) and to assess the reduction of the risk of introducing disease into dairy cattle. Visits were made to 70 dairy and dual-purpose beef/dairy farms, where the survey was conducted to evaluate technical aspects relating to epidemiological surveillance and the risk of introducing disease. In only one of the nine areas of application covered in the guide was compliance with technical requirements greater than 70%: milking and milk handling (78.59%). In the following areas, a compliance rate of 40-65% was achieved: records and traceability; siting of livestock farms and infrastructure, facilities and equipment; use and quality of water and animal feed; and management of veterinary products and agricultural pesticides. In the remaining areas, the compliance rate was less than 20%. On average, there was only 27.96% compliance with the technical elements evaluated. The results show that current guidelines for good dairy farming practices can be used to evaluate basic aspects of epidemiological surveillance and of the reduction of the risk of introducing disease into dairy farms. They also reveal shortcomings in these aspects in the Amazonian province of Pastaza, which need to be addressed appropriately to reduce their negative impact on animal health.

Les auteurs décrivent une étude réalisée dans les exploitations bovines laitières de la province de Pastaza (Équateur) afin de déterminer le niveau de conformité des activités de surveillance épidémiologique et d'atténuation du risque d'introduction de diverses maladies animales. L'enquête portait sur les principales exigences techniques décrites dans le Guide de bonnes pratiques d'élevage en production laitière. À cette fin, 70 exploitations bovines laitières ou mixtes ont été inspectées pour évaluer leurs performances en termes de surveillance épidémiologique et d'atténuation du risque d'introduction de maladies. Parmi les neuf domaines opérationnels décrits dans le Guide, seules la traite et la gestion du lait étaient conformes à plus de 70 % des exigences techniques (78,59 %). Pour les domaines suivants, la conformité portait sur 40 % à 65 % des exigences techniques : enregistrement et traçabilité ; agencement des élevages et des infrastructures, installations et équipements ; utilisation et qualité de l'eau et des aliments donnés aux animaux ; gestion des produits à usage vétérinaire et des insecticides à usage agricole. Les autres opérations étaient conformes à moins de 20 % des exigences techniques. En moyenne, 27,96 % seulement des exigences techniques évaluées étaient respectées. Les résultats de l'étude démontrent que les guides de bonnes pratiques d'élevage en production laitière peuvent servir de base pour évaluer les principaux aspects de la surveillance épidémiologique et des mesures d'atténuation des risques d'introduction de maladies dans les cheptels laitiers ; d'autre part, l'étude a révélé des défaillances concernant ces aspects dans la province amazonienne de Pastaza, auxquelles il conviendra de prêter l'attention nécessaire afin de limiter leur impact négatif sur la santé animale.

Con el objetivo de realizar un análisis del grado de cumplimiento de las actividades de vigilancia epidemiológica y la reducción de riesgo de entrada de enfermedades en los predios productores de leche bovina de la provincia Pastaza, tomando como base los principales aspectos técnicos contemplados en la Guía de Buenas Prácticas Pecuarias de Producción de Leche, se visitaron 70 predios lecheros y de doble propósito, en los que se realizó una encuesta que incluía aspectos relacionados con la vigilancia epidemiológica y el riesgo de introducción de enfermedades. De las nueve áreas establecidas en la guía, solo cumple más del 70% de los aspectos técnicos el área de ordeño y manejo de la leche (78,59%). Cumplen entre el 40% y el 65% las siguientes áreas: documentos y trazabilidad; ubicación de las explotaciones pecuarias e infraestructura, instalaciones y equipos; uso y calidad del agua y de la alimentación animal; y manejo de productos de uso veterinario y plaguicidas de uso agrícola; el resto cumplen menos de un 20%. De media, se cumple solo el 27,96% de los elementos técnicos evaluados. Los resultados demuestran que, a partir de las guías establecidas para las buenas prácticas pecuarias de producción de leche, se pueden evaluar los aspectos básicos de vigilancia epidemiológica y de reducción de riesgos de introducción de enfermedades en los predios lecheros, y que en la provincia amazónica de Pastaza existen deficiencias en estos aspectos, a los cuales es necesario brindar la atención adecuada para reducir el impacto negativo que ejercen en la sanidad animal.

Rapid antidepressant effects: moving right along.

Available treatments for depression have significant limitations, including low response rates and substantial lag times for response. Reports of rapid antidepressant effects of a number of compounds, including the glutamate N-methyl-D-aspartate receptor antagonist ketamine, have spurred renewed translational neuroscience efforts aimed at elucidating the molecular and cellular mechanisms of action that result in rapid therapeutic response. This perspective provides an overview of recent advances utilizing compounds with rapid-acting antidepressant effects, discusses potential mechanism of action and provides a framework for future research directions aimed at developing safe, efficacious antidepressants that achieve satisfactory remission not only by working rapidly but also by providing a sustained response.

[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.

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.

Within-farm spread of infectious salmon anemia virus (ISAV) in Atlantic salmon Salmo salar farms in Chile.

Spread of infectious salmon anemia virus (ISAV) at the cage level was quantified using a subset of data from 23 Atlantic salmon Salmo salar farms located in southern Chile. Data collected from official surveillance activities were systematically organized to obtain detailed information on infectious salmon anemia (ISA) outbreaks. Descriptive statistics for outbreak duration, proportion of infected fish, and time to secondary infection were calculated to quantify the magnitude of ISAV incursions. Linear and multiple failure time (MFT) regression models were used to determine factors associated with the cage-level reproduction number (Rc) and hazard rate (HR) for recurrent events, respectively. In addition, the Knox test was used to assess if cage-to-cage transmissions were clustered in space and time. Findings suggest that within farms, ISA outbreaks, on average, lasted 30 wk (median = 26 wk, 95% CI = 24 to 37 wk) and affected 57.3% (95% CI = 47.7 to 67.0%) of susceptible cages. The median time to secondarily diagnosed cages was 23 d. Occurrence of clinical ISAV outbreaks was significantly associated with increased Rc, whereas increased HR was significantly associated with clinical outbreaks and with a large number of fish. Spatio-temporal analysis failed to identify clustering of cage cases, suggesting that within-farm ISAV spread is independent of the spatial location of the cages. Results presented here will help to better understand ISAV transmission, to improve the design of surveillance programs in Chile and other regions in which salmon are intensively farmed, and to examine the economic impact of ISAV and related management strategies on various cost and demand shifting factors.

First Report of Fusarium commune Causing Damping-off, Seed Rot, and Seedling Root Rot on Soybean (Glycine max) in the United States.

During 2007 to 2009, symptomatic and asymptomatic soybean plants were collected from fields in 18 Iowa counties. Fusarium isolates were recovered from surface-sterilized root tissue on peptone PCNB agar (2). Single-spore isolates were transferred to synthetic low nutrient agar (SNA) overlain with pieces (1 × 2 cm) of sterile filter paper, and to potato dextrose agar (PDA), and placed in the dark for 10 to 14 days for morphological identification (4). Twenty-three isolates were identified as Fusarium commune K. Skovg., O'Donnell & Nirenberg, previously in the F. oxysporum species complex (4). Colonies on PDA had white, fluffy, aerial mycelium with magenta to violet pigmentation in the medium. On SNA, macroconidia, chlamydospores, and microconidia on monophialides and polyphialides were consistent with the species description (4). Identification of all 23 isolates was confirmed by DNA sequencing of the translation elongation factor (EF1-α) gene, using ef1 and ef2 primers, and the mitochondrial small subunit (mtSSU), using primers MS1 and MS2 (4) [GenBank accessions for two representative isolates: EF1-α (JX289892 and JX289893), and mtSSU (JX289894 and, JX289895)]. Pathogenicity of two representative isolates of F. commune was tested on soybean (cv. AG2403) in a greenhouse, in water baths set at 18°C, using autoclaved soil mixed with infested sand-cornmeal inoculum (3). The experiment entailed a completely randomized design (CRD) with five replications (single plant/150 ml cone) per treatment, and was conducted three times. Dry root and shoot weights, and root rot severity (visual estimate of percent root rot on the entire root system) were evaluated after 6 weeks. Mean seedling emergence in soil infested with F. commune was 47 and 40% for the two isolates; in contrast, non-inoculated control plants had 100% emergence. There were significant differences in root (P < 0.0001) and shoot (P < 0.0001) weights, and root rot severity (P < 0.0001), between inoculated and non-inoculated plants. Seedlings that emerged were severely stunted and had dark brown lesions. F. commune was reisolated from infected roots of inoculated plants, but not from non-inoculated plants. Pathogenicity of both isolates to soybean (cv. MN1805) was also tested using a petri dish assay, in which eight seeds were placed on a plate with a 4-day-old culture growing on 2% water agar (1). Plates were rated 7 days later for seed germination, seed rot, and lesion development, using an ordinal scale (1). The experiment entailed a CRD with three replicate plates/treatment, and was conducted three times. Germination of inoculated seeds ranged from 37.5 to 75.0%, and germinated seedlings had dark brown lesions on the taproots. There was a significant difference between isolates in the petri dish assay (P = 0.0030); one isolate was less aggressive, but both isolates resulted in significantly more disease than on the non-inoculated control plants, which had 100% germination and no symptoms (P < 0.0001). F. oxysporum is a known soybean pathogen (1), but isolates of F. commune may have been misidentified as F. oxysporum in previous studies. To our knowledge, this is the first report of F. commune as a pathogen on soybean in the U.S.A. References: (1) K. E. Broders et al. Plant Dis. 91:727, 2007. (2) J. F. Leslie and B. A. Summerell. The Fusarium Laboratory Manual. Blackwell Publishing, Oxford, UK, 2006. (3) G. P. Munkvold and J. K. O'Mara. Plant Dis. 86:143, 2002. (4) K. Skovgaard et al. Mycologia. 94:630, 2003.

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.

[News on venous thromboembolic disease]. / Novedades en la enfermedad tromboembólica venosa.

This paper brings together the latest developments that have occurred in different aspects of venous thromboembolism (VTE): VTE prophylaxis in high-risk orthopedic surgery and acutely ill hospitalized medical patients; therapeutic advances in pulmonary embolism and superficial vein thrombosis and VTE future prospects. It summarizes the reviews that five speakers made in-depth for the Second Day in New Anticoagulant Treatment, held in Madrid on November 18, 2011, organized by the Foundation for the Study of Thromboembolic Disease in Spain and endorsed by the Spanish Society of Internal Medicine, Spanish Society of Pneumology and Thoracic Surgery, Spanish Society of Cardiology, Spanish Society of Thrombosis and Haemostasis and the Spanish Society of Angiology and Vascular Surgery.

[Clinical usefulness of three quantitative D-dimers tests in outpatients with suspected deep vein thrombosis]. / Análisis de 3 métodos para determinar el dímero D en pacientes con sospecha de trombosis venosa profunda.

BACKGROUND AND OBJECTIVE: The diagnostic approach in outpatients with suspected deep vein thrombosis (DVT) of the lower limbs includes D-dimer measurement (DD). Elevated DD is not a diagnostic value for DVT. However, a normal value contributes to ruling out DVT. We do not know the best method to determine DD. Therefore, we have analyzed the clinical utility of three quantitative assays to determine DD in outpatients with suspected DVT. PATIENTS AND METHODS: Consecutive outpatients with suspected DVT of the lower limbs who were referred to the DVT medical consultation were enrolled in the study. We used a diagnostic algorithm that included determining the pretest clinical probability (PCP) (Wells scale), DD level using three different quantitative methods (ELISA mini-VIDAS(®), Acure-care DDMR and DD-Plus). The DVT diagnosis was confirmed by seriated compression ultrasonography of the lower limbs. We analyzed the concordance between the three analytic methods to quantify DD and the characteristics. RESULTS: A total of 306 patients (mean age 60 years, 62% women) with suspected DVT of the lower limbs were included. The compression ultrasonography confirmed the diagnosis of DVT in 23.8% of the patients. Anticoagulation treatment was not performed in patients in whom DVT was ruled out, and no thromboembolic event occurred during the 3 months of follow-up. The best concordance test results were between ELISA mini-VIDAS(®) and Acure-care DDMR assays. Both assays demonstrated elevated sensibility and a negative predictive value. ELISA mini-VIDAS(®) was the best analytic method for the subgroup of patients with low clinical probability. CONCLUSIONS: The ELISA mini-VIDAS(®) method to determine DD rules out DVT in patients with low clinical probability.

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.

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.

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.

[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.

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.

Opening the gate: framework flexibility in ZIF-8 explored by experiments and simulations.

ZIF-8 is a zeolitic imidazole-based metal-organic framework with large cavities interconnected by narrow windows. Because the small size of the windows, it allows in principle for molecular sieving of gases such as H(2) and CH(4). However, the unexpected adsorption of large molecules on ZIF-8 suggests the existence of structural flexibility. ZIF-8 flexibility is explored in this work combining different experimental techniques with molecular simulation. We show that the ZIF-8 structure is modified by gas adsorption uptake in the same way as it is at a very high pressure (i.e., 14,700 bar) due to a swing effect in the imidazolate linkers, giving access to the porosity. Tuning the flexibility, and so the opening of the small windows, has a further impact on the design of advanced molecular sieving membrane materials for gas separation, adjusting the access of fluids to the porous network.

HbA(1c) in adults without known diabetes from southern Europe. Impact of the new diagnostic criteria in clinical practice.

AIMS: To analyse the differences in the prevalence of diabetes and dysglycaemia using fasting plasma glucose and HbA(1c) criteria. METHODS: Analytical cross-sectional study undertaken in a random sample of 2144 individuals (age 18-80 years) without known diabetes from the primary care setting in Malaga (Spain). Dysglycaemia was defined as fasting plasma glucose 5.6-6.9 mmol/l or HbA(1c) 39-46 mmol/mol (5.7-6.4%) and diabetes as fasting plasma glucose ≥ 7.0 mmol/l or HbA(1c)≥ 48 mmol/mol (≥ 6.5%). RESULTS: The proportion of subjects who were normoglycaemic was significantly higher using fasting plasma glucose than HbA(1c) (83.5 vs. 65%) (P < 0.0001). Compared with fasting plasma glucose, HbA(1c) detects more cases of dysglycaemia (32 vs. 14.8%) (P < 0.0001) and diabetes (3 vs. 1.7%) (P < 0.0001). CONCLUSIONS: In our environment, using HbA(1c) for the diagnosis of pre-diabetes and diabetes could increase the target population for preventive and therapeutic measures. Further cost-effectiveness studies are needed before the widespread diagnostic use of HbA(1c) can be recommended.