Bypass of Booming Inputs of Urban and Sludge-Derived Microplastics in a Large Nordic Lake.

Microplastic research, initially focusing on marine environments, left freshwater ecosystems largely unexplored. Freshwaters are also vulnerable to microplastics and are likely the largest microplastic supplier to the ocean. However, microplastic sources, transport pathways, and fluxes at the catchment level remain to be quantified, compromising efficient actions toward mitigation and remediation. Here we show that 70-90% of microplastics reaching Norway's largest lake, originating primarily from urban waste mismanagement and sludge application on crops, continue their journey toward the ocean without being buried. Indeed, our microplastic budget for the catchment shows that out of the 35.9 tons (7.4-119.4 t) of microplastics annually released into the lake, only 3.5 tons (1.3-8.8 t) are settling to the lake bottom. The spatial and vertical microplastic distribution and diversity in lake sediments, the socio-economic modeling of plastic fluxes and spatial information on land use and potential plastic sources all point toward urban and agricultural areas as emission hotspots of increasing importance. We conclude that the degree to which lake sediments represent a net microplastic sink is likely influenced by the nature of microplastics the lake receives, and ultimately on their origin.

Treatment of faecal incontinence with autologous expanded mesenchymal stem cells: results of a pilot study.

AIM: Management of faecal incontinence (FI) remains challenging because no definitive optimal treatment for this condition has yet been determined. Regenerative medicine could be an attractive therapeutic alternative for treating FI. Here, we aimed to determine the safety and feasibility of autologous expanded mesenchymal stem cells derived from adipose tissue (AdMSCs) in the treatment of patients diagnosed with structural FI. METHOD: This was a randomized, multicentre, triple-blinded, placebo-controlled pilot study conducted at four sites in Spain with 16 adults with FI and a sphincter defect. Autologous AdMSCs were obtained from patients from surgically excised adipose tissue. These patients were intralesionally infused with a single dose of 4 × 107 AdMSCs or a placebo while under anaesthesia. We assessed the safety and feasibility of the treatment as the cumulative incidence of adverse events and the treatment efficacy using the Cleveland Clinic Faecal Incontinence Score, Faecal Incontinence Quality of Life score and Starck criteria to classify sphincter defects and anorectal physiology outcomes. RESULTS: Adipose tissue extraction, cell isolation and intralesional infusion procedures were successful in all the patients. There was only one adverse event connected to adipose tissue extraction (a haematoma), and none was associated with the injection procedure. There were no significant differences in any of the assessed clinical, manometric or ultrasonographic parameters. CONCLUSION: This study indicates that this infusion procedure in the anal sphincter is feasible and safe. However, it failed to demonstrate efficacy to treat patients with structural FI.

Gamma-linolenic Acid from Fifty-seven Ribes Species and Cultivars.

γ-linolenic acid (GLA, 18:3n-6) is a bioactive fatty acid (FA) that exerts several healthy actions; however, its occurrence is restricted to a few oils. The goal of this study was to detect GLA-rich Ribes species and cultivars (cv), and to achieve this the seeds of 7 Ribes taxa and 50 Ribes cv were surveyed for FA profiles. The highest GLA percentages were found in R. nigrum cv 'Plotnokistnaya', 'Volshebnica', 'Atlant' and 'Nara' (22.6, 22.1, 20.9, and 20.0% of total FA, respectively) and also in R. komarovii (19.6%) and R. nigrum var. sibiricum (18.3%). Stearidonic acid (SDA, 18:4n-3) had the highest values in both R. rubrum 'Konstantinovskaya' and R. niveum 'Smolyaninovskaya' (4.8%). GLA content ranged from 0.4 in some R. rubrum cv and R. niveum 'Smolyaninovskaya' to 3.5 g/100 g seeds in R. nigrum 'Plotnokistnaya'. Principal component analysis (PCA) was performed using PUFA profiles, which allowed grouping Ribes sections as well as black currant cv derived from different pedigree within the section Coreosma. All taxa and cv checked here are valuable by-product sources, given the high GLA percentages contained in their seed oils. Such cv could be used for healthy oils production, as well as for breeding to obtain new cv with improved GLA concentrations.

LED Enhances Plant Performance and Both Carotenoids and Nitrates Profiles in Lettuce.

Recent studies show that vegetables at early stage of development contain higher amounts of phytonutrients and minerals, and lower amounts of nitrates than at fully developed stage. Nevertheless, the effects of some spectrum light on the carotenoid content of lettuce microgreens are unknown. Three different LED lamps were checked: (i) artificial white light (T0); (ii) continuous light-emitting diodes with longer blue-wavelength (T1), and (iii) continuous light-emitting diodes with longer red-wavelength (T2). Different lettuce cvs. were grown under the above described lamps. Plants were collected after 10, 15, 35 and 50 days from planting to produce sprouts, microgreens, initial baby leaf, and baby leaf, respectively. Response to different continuous spectrum lights related to productivity and nitrate content was variable for the different plants. Accumulation of nitrates at initial stages in plant tissues was clearly lower than at final stages of crop development, ranging from 50.2 to 73.4 mg 100 g1 fresh weight for T2. Lettuce consumption is preferable at microgreen stage in comparison with baby leaf stage. Nitrate amounts at microgreen stage were lower than in baby leaf stage, and this content was inversely correlated with carotenoid content, which in tissues was higher at microgreens stage influenced by LED.

γ-Linolenic and Stearidonic Acids from Boraginaceae of Diverse Mediterranean Origin.

Thirty Boraginaceae species from different tribes were evaluated in a search of γ-linolenic (GLA, 18:3n-6) and stearidonic acid (SDA, 18:4n-3)-rich oils. The high GLA percentages were found in the seed oils of Symphytum bulbosum and S. tuberosum subsp. tuberosum (27.6 and 27.2 % of total fatty acids (FA)), which are unusually high values for GLA-oils in the current literature. On the whole seed, noticeable GLA percentages were found in S. grandiflorum, S. tuberosum subsp. tuberosum and Borago officinalis (7.43, 4.90, and 4.51 g/100 g, respectively). The main SDA-taxa detected in this study were Buglossoides arvensis, B. incrassata and Glandora oleifolia (21.3, 18.9, and 16.3 % of total fatty acids). On total seed weight, Glandora rosmarinifolia showed the highest SDA content (3.57 g/100 g). Finally, the higher FA contents were found in S. grandiflorum and Paramoltkia doerfleri seeds (35.2 and 37.0 g/100 g, respectively). Principal component analysis showed that similarities in FA profiles allow grouping species as botanical criteria for Boraginaceae tribes do, while the FA groupings confirm the metabolic activities of desaturase and elongase enzymes. Data on the FA composition of the seed oils analyzed here suggest their potential use as functional foods and can be considered as novel sources of SDA and GLA.

Urinary proteomics for prediction of mortality in patients with type 2 diabetes and microalbuminuria.

BACKGROUND: The urinary proteomic classifier CKD273 has shown promise for prediction of progressive diabetic nephropathy (DN). Whether it is also a determinant of mortality and cardiovascular disease in patients with microalbuminuria (MA) is unknown. METHODS: Urine samples were obtained from 155 patients with type 2 diabetes and confirmed microalbuminuria. Proteomic analysis was undertaken using capillary electrophoresis coupled to mass spectrometry to determine the CKD273 classifier score. A previously defined CKD273 threshold of 0.343 for identification of DN was used to categorise the cohort in Kaplan-Meier and Cox regression models with all-cause mortality as the primary endpoint. Outcomes were traced through national health registers after 6 years. RESULTS: CKD273 correlated with urine albumin excretion rate (UAER) (r = 0.481, p = <0.001), age (r = 0.238, p = 0.003), coronary artery calcium (CAC) score (r = 0.236, p = 0.003), N-terminal pro-brain natriuretic peptide (NT-proBNP) (r = 0.190, p = 0.018) and estimated glomerular filtration rate (eGFR) (r = 0.265, p = 0.001). On multivariate analysis only UAER (ß = 0.402, p < 0.001) and eGFR (ß = - 0.184, p = 0.039) were statistically significant determinants of CKD273. Twenty participants died during follow-up. CKD273 was a determinant of mortality (log rank [Mantel-Cox] p = 0.004), and retained significance (p = 0.048) after adjustment for age, sex, blood pressure, NT-proBNP and CAC score in a Cox regression model. CONCLUSION: A multidimensional biomarker can provide information on outcomes associated with its primary diagnostic purpose. Here we demonstrate that the urinary proteomic classifier CKD273 is associated with mortality in individuals with type 2 diabetes and MA even when adjusted for other established cardiovascular and renal biomarkers.

Centenarians and their hearts: A prospective registry with comprehensive geriatric assessment, electrocardiogram, echocardiography, and follow-up.

BACKGROUND: Data on the cardiac characteristics of centenarians are scarce. Our aim was to describe electrocardiogram (ECG) and echocardiography in a cohort of centenarians and to correlate them with clinical data. METHODS: We used prospective multicenter registry of 118 centenarians (28 men) with a mean age of 101.5±1.7 years. Electrocardiogram was performed in 103 subjects (87.3%) and echocardiography in 100 (84.7%). All subjects underwent a follow-up for at least 6 months. RESULTS: Centenarians with abnormal ECG were less frequently females (72% vs 93%), had higher rates of previous consumption of tobacco (14% vs 0) and alcohol (24% vs 12%), and scored lower in the perception of health status (6.8±2.0 vs 8.3±6.8). Centenarians with significant abnormalities in echocardiography were less frequently able to walk 6 m (33% vs 54%). Atrial fibrillation/flutter was found in 27 subjects (26%). Mean left ventricular (LV) ejection fraction was 60.0±10.5%. Moderate or severe aortic valve stenosis was found in 16%, mitral valve regurgitation in 15%, and aortic valve regurgitation in 13%. Diastolic dysfunction was assessed in 79 subjects and was present in 55 (69.6%). Katz index and LV dilation were independently associated with the ability to walk 6 m. Age, Charlson and Katz indexes, and the presence of significant abnormalities in echocardiography were associated with mortality. CONCLUSIONS: Centenarians have frequent ECG alterations and abnormalities in echocardiography. More than one fifth has atrial fibrillation, and most have diastolic dysfunction. Left ventricular dilation was associated with the ability to walk 6 m. Significant abnormalities in echocardiography were associated with mortality.

Assessment of metal(loid) and natural radionuclide pollution in surface sediments of an estuary affected by mining and phosphogypsum releases.

The prolonged impact over the Tinto River estuary by both the significant pollution by acid mine drainage (AMD) affecting this river and the polluted releases from phosphogypsum (PG) piles has led to the severe environmental degradation of this ecosystem. The aim of this work was to assess the current environmental quality of the Tinto River estuary through the study of the spatial distribution of metal(loid)s and natural radionuclides in the surface sediments from the channel edge. The sediments contain mean concentrations 5-20 times higher than the background values for pollutants such as Zn, As, Cu, Pb, or U, and up to two orders of magnitude higher for P. The studied sediments are heavily polluted by toxic heavy metals and metalloids (Pb, Zn, Cu, and As) according to the US EPA guidelines. Most of the analyzed sediment samples are also strongly polluted by long-lived natural radionuclides, mainly U-isotopes and 210Pb with concentrations up to one order of magnitude higher than unpolluted sediments, mostly due to the contribution by the PG leachates. The enrichment factors (EF) were extremely high (EF > 50) for As and very severe enrichment (25 ≤ EF < 50) for P, Cd, Zn, Cu, and Pb.

Corrigendum: Case report: Unveiling a less severe congenital nephrotic syndrome in a Rapa Nui patient with a NPHS1 Maori founder variant.

[This corrects the article DOI: 10.3389/fneph.2024.1379061.].

Case report: Unveiling a less severe congenital nephrotic syndrome in a Rapa Nui patient with a NPHS1 Maori founder variant.

Background: Congenital nephrotic syndrome (CNS) is a severe kidney disorder characterized by edema, massive proteinuria, and hypoalbuminemia that manifests in utero or within three months after birth. CNS affects 1-3 per 100,000 children, primarily associated with genetic variants and occasionally with infections. Genetic analysis is the first-line method for diagnosis. The most common founder variants have been identified in European populations, often resulting in end-stage kidney disease by 1-2 years of age. Case-diagnosis/treatment: A female full-term neonate, without prenatal signs of kidney disease, was admitted to Rapa Nui (Eastern Island) Hospital at the age of 2 months due to bronchial obstruction. She presented fever, oliguria, edema, urine protein-to-creatinine ratio (UPCR) 433.33, and hypoalbuminemia (0.9 g/dL). She was transferred to a mainland Chilean hospital following CNS diagnosis. Viral screening detected cytomegalovirus (CMV) positivity in both blood and urine. A kidney biopsy revealed interstitial nephritis and diffuse podocyte damage and the tissue PCR resulted negative for CMV. Interviews with the parents revealed consanguinity, suggestive of hereditary CNS. Genetic analysis identified the Maori founder variant, NPHS1 c.2131C>A (p.R711S), in homozygosis. The patient received albumin infusions and antiviral therapy, being discharged when she was 5 months old, with improved laboratory parameters evidenced by UPCR 28.55, albumin 2.5 g/dL, and cholesterol 190 mg/dL. Subsequent clinical monitoring was conducted through virtual and in-person consultations. At her last follow-up at 4 years 2 months old, she presented UPCR 16.1, albumin 3.3 g/dl and cholesterol 220 mg/dL, maintaining normal kidney function and adequate growth. Conclusions: To our knowledge, this represents the first case of CNS in Chile carrying a NPHS1 variant associated with prolonged kidney survival. As described in the Maori population, the patient exhibited a less severe clinical course compared to classical NPHS1 patients. Genetic testing for the Maori founder variant in CNS patients related to the New Zealand population, could impact management decisions and potentially prevent the need for nephrectomies.

Influence of storage variables on the antioxidant and antitumor activities, phenolic compounds and vitamin C of an agglomerate of Andean berries.

Berry consumption is increasing worldwide due to their high content of bioactive compounds. However, such fruits have a very short shelf life. To avoid this drawback and to offer an effective alternative for its consumption at any time of the year, an agglomerated berry powder mix (APB) was developed. The aim of this work was to evaluate the stability of APB during a 6-months-period storage at 3 temperatures. The stability of APB was determined by moisture, aw, antioxidant activity, total phenolics, total anthocyanins, vitamin C, color, phenolic profiles, and MTT assay. APB showed differences in antioxidant activity between 0 and 6 months. It experimented non-enzymatic browning, which was more remarkable at 35 °C. APB at time 0 exhibited growth inhibitory effects against HT-29 human cancer cells. Most properties were significantly modified by storage temperature and time, which induces a significant decreasing of bioactive compounds.

Arecaceae Seeds Constitute a Healthy Source of Fatty Acids and Phenolic Compounds.

Seeds of most Arecaceae species are an underutilized raw material that can constitute a source of nutritionally relevant compounds. In this work, seeds of 24 Arecaceae taxa were analyzed for fatty acids (FAs) by GC-FID, for phenolics by HPLC-DAD and LC-MS, and for their antitumor activity against the HT-29 colorectal cancer cell line by the MTT assay. Lauric, oleic, and linoleic acids were the prominent FAs. Cocoseae species contained total FAs at 28.0-68.3 g/100 g seeds, and in other species total FAs were from 1.2 (Livistona saribus) to 9.9 g/100 g (Washingtonia robusta). Sabal domingensis, Chamaerops humilis, and Phoenix dactylifera var. Medjool had unsaturated/saturated FA ratios of 1.65, 1.33-1.78, and 1.31, respectively, and contained 7.4, 5.5-6.3, and 6.4 g FAs/100 g seeds, respectively. Thus, they could be used as raw materials for healthy oilseed production. Phenolics ranged between 39 (Livistona fulva) and 246 mg/100 g (Sabal palmetto), and of these, caffeic acid, catechin, dactylifric acid, and rutin had the highest values. (-)-Epicatechin was identified in most seed extracts by LC-MS. Hydroalcoholic extracts from five species showed a dose-dependent inhibitory effect on HT-20 cells growth at 72 h (GI50 at 1533-1968 µg/mL). Overall, Arecaceae seeds could be considered as a cheap source of health-promoting compounds.

Screening of Lesser-Known Salted-Dried Fish Species for Fatty Acids, Tocols, and Squalene.

The fillets and roes of 29 species of dry-salted fishes consumed in Eurasian countries were analyzed for fatty acids (FAs), tocols, and squalene, looking for derived health benefits. FAs were analyzed by GC-FID, and tocols and squalene were analyzed by HPLC-DAD. With some exceptions, docosahexaenoic (DHA, 22:6n-3), eicosapentaenoic (EPA, 20:5n-3), and arachidonic (ARA, 20:4n-6) acids were the prominent polyunsaturated fatty acids (PUFAs). The fillets of Scardinius erythrophthalmus reached the highest amounts of total FAs, ARA, and DHA (23.1, 1.82, and 2.49 mg/100 g). The fillets of Seriola quinqueradiata showed the highest percentages of DHA (34.4% of total FAs). Nutritional quality indices for fish lipids were favorable in all samples, especially the n-6/n-3 PUFA ratio, which was below 1 in most cases. α-Tocopherol was found in all fillets and roes, especially in Cyprinidae and Pleuronectidae species, and the highest value was found in the roes of Abramis brama (5.43 mg/100 g). Most samples contained tocotrienols at trace levels. The fillets of Clupeonella cultriventris contained the highest amounts of squalene (1.83 mg/100 g). Overall, dry-salted fish stand out due to their high concentrations of ARA, EPA, and DHA, as well as for α-tocopherol concentrations in roes.

Metabarcoding data of prokaryotes and eukaryotes inhabiting the phosphogypsum stockpiles on the salt marshes of Huelva (SW Spain).

Around 100 Mt of phosphogypsum (PG) of extreme acidity and with high concentrations of heavy metals and radionuclides have been deposited on the salt marshes of the Tinto River estuary in Huelva (SW Spain) for more than forty years. The microbial community able to thrive in these adverse conditions remains totally unknown, despite the fact that it can highly influence the biogeochemical cycle of the phosphogypsum components and include new species with biotechnological interest. High throughput sequencing of 16S/18S rRNA encoding genes is a potent tool to uncover the microbial diversity of extreme environments. This data article describes for the first time the prokaryotic and eukaryotic diversity of two water samples collected in the Huelva phosphogypsum stacks. The raw amplicons of the 16S/18S rRNA maker genes for the two phosphogypsum samples and two reference samples (seawater and the Tinto River water) obtained after sequencing on MiSeq platform are provided. The operational taxonomic units (OTUs) obtained after the treatment and clustering of the obtained reads with the QIIME2 pipeline and their taxonomic assignation performed by comparison with the SILVA database are also presented to complete the information of the article "Exploring the microbial community inhabiting the phosphogypsum stacks of Huelva (SW, Spain) by a high throughput 16S/18S rDNA Sequencing approach".

Exploring the microbial community inhabiting the phosphogypsum stacks of Huelva (SW SPAIN) by a high throughput 16S/18S rDNA sequencing approach.

Around 100 Mt of phosphogypsum (PG) have been deposited in large stacks on the salt marshes of the Tinto River estuary in Huelva (SW Spain), covering about 1000 ha. These stacks contain extremely acidic water (pH < 2) with high concentrations of pollutants which can cause emissions into their surroundings, generating important environmental concerns. Despite many chemical, geological or hydrological studies have been conducted to characterize the PG stacks of Huelva, the microbial community inhabiting this extreme environment remains unexplored. Using a 16S/18S-rRNA-high throughput sequencing approach, we have uncovered the main taxonomic groups able to live in the acidic metal-contaminated water, which is in direct contact with the PG, demonstrating for the first time the existence of a huge diversity of microbial species in these extreme conditions. In addition, the physicochemical characteristics of the water sampled have been analyzed. These studies have revealed that the most abundant bacteria found in two different leachate samples of the PG stacks belong to the genera Acidiphilium, Pseudomonas, Leptosprillum, Acidithrix, or Acidithiobacillus, typically found in acid mine drainage (AMD) environments, which in total represent around 50% of the total bacterial community. Biodiversity of eukaryotes in PG water is lower than that of prokaryotes, especially in the water collected from the perimeter channel that surrounds the PG stacks, where the pH reaches a value of 1.5 and the activity concentrations exceed 300 Bq L-1 for 238U or 20 Bq L-1 for 210Po, values which are from four to five orders of magnitude higher than those usually found in unperturbed surface waters. Even so, an unexpected diversity of algae, fungi, and ciliates have been found in the PG stacks of Huelva, where chlorophyte microalgae and basidiomycetes fungi are the most abundant eukaryotes. Additional bioinformatics tools have been used to perform a functional analysis and predict the most common metabolic pathways in the PG microbiota. The obtained data indicate that the extreme conditions of these PG stacks hide an unexpected microbial diversity, which can play an important role in the dynamics of the contaminating compounds of the PG and provide new strains with unique biotechnological applications.

Effects of a Home-Based Exercise Program on Health-Related Quality of Life and Physical Fitness in Dementia Caregivers: A Randomized Controlled Trial.

Regular exercise can be an effective health-promotion strategy to improve the physical and mental health of informal caregivers. A randomized controlled trial study was designed to evaluate the effects of a 9-month home-based exercise intervention on health-related quality of life (HRQoL) and physical fitness in female family caregivers of persons with dementia. Fifty-four female caregivers were randomly assigned to two groups for the 9-month study period. Participants of the intervention group (n = 25) performed two 60-min exercise sessions per week at home, under the direct supervision of a personal trainer. Participants in the control group (n = 23) continued their habitual leisure-time activities. HRQoL was assessed using the SF-36 questionnaire, and physical fitness was measured using a battery of appropriate fitness tests. After 9 months, significant improvements were observed in general health, social function, vitality, hand and leg strength, trunk flexor and extensor endurance, and aerobic endurance in the intervention group. The present intervention was highly adherent and safe for the participants, with no dropout related to the intervention. As a home-based exercise program conducted by a personal trainer face to face, it can be considered as a feasible and appropriate method to improve the most deficient HRQoL dimensions and contribute to preserving the functional capacity of female family caregivers of persons with dementia.

Buglossoides spp. seeds, a land source of health-promoting n-3 PUFA and phenolic compounds.

Ahiflower oil© is extracted from the seeds of Buglossoides arvensis, which contains high amounts of stearidonic acid (SDA, 18:4n-3), while its phenolic composition still is unreported. Moreover, several Buglossoides taxa remain unstudied and could become natural sources of SDA. In this work, seeds of several Buglossoides taxa and Ahiflower oil© were screened for fatty acids, phenolic compounds, and in vitro antiproliferative activities against colorectal cancer cells. Four flavonoids and 16 phenolic acids were identified and quantified. Among Buglossoides taxa, the highest amounts of phenolic compounds were found in samples collected in Spain, under a warm Mediterranean climate. Rosmarinic and lithospermic acids were the main phenols found in Buglossoides seeds. The MTT assay showed dose- and time-dependent inhibitory effects of B. arvensis extracts on HT-29 cancer cells, with a GI50value of ∼280 µg/mL after 72 h of cell exposure to seed extracts. The latter showed lower antiproliferative activity than that of pure phenolics due to the simultaneous presence of other compounds in the extracts, as evidenced by 1H NMR. This work constitutes the first approach to evaluate the seeds of several Buglossoides taxa as functional oils-providers to use them as functional foods.

Early steroid withdrawal in pediatric renal transplant: five years of follow-up.

This prospective, comparative trial investigated the impact on mean change in height standard deviation score (SDS), acute rejection rate, and renal function of early steroid withdrawal in 96 recipients with 5 years of follow-up. Recipients under basiliximab induction and steroid withdrawal (SW: TAC/MMF; n = 55) were compared with a matched steroid control group (SC: TAC/MMF/STEROID, n = 41). SW received steroids until Day 6, SC decreased to 10 mg/m(2) within 2 months post-transplant. Five years after SW, the longitudinal growth (SDS) gain was 1.4 ± 0.4 vs. 1.1 ± 0.3 for SC group (p < 0.02). Height benefits in prepubertal and pubertal status in both groups were demonstrated in the delta growth trends (mixed model; p < 0.01). Biopsy-proven acute rejection in SW was 11% and 17.5%, SC (p: ns). Mean eGFR (ml/min/1.73 m(2)) at 5 years post-transplant was SW 80.6 ± 27.8 vs. 82.6 ± 25.1 for SC (p: ns). The death-censored graft survival rate at 1 and 5 years was 99 and 90% for SW; 98 and 96% for SC (p = ns). PTLD incidence in SW 3.3 vs. 2.5% in SC (p: ns). Five years post-transplant, early steroid withdrawal showed positive impacts on growth, stable renal function without increased acute rejection risk, and PTLD incidence.

Rationale and methods of the multicenter randomised trial of a heart failure management programme among geriatric patients (HF-Geriatrics).

BACKGROUND: Disease management programmes (DMPs) have been shown to reduce hospital readmissions and mortality in adults with heart failure (HF), but their effectiveness in elderly patients or in those with major comorbidity is unknown. The Multicenter Randomised Trial of a Heart Failure Management Programme among Geriatric Patients (HF-Geriatrics) assesses the effectiveness of a DMP in elderly patients with HF and major comorbidity. METHODS/DESIGN: Clinical trial in 700 patients aged ≥ 75 years admitted with a primary diagnosis of HF in the acute care unit of eight geriatric services in Spain. Each patient should meet at least one of the following comorbidty criteria: Charlson index ≥ 3, dependence in ≥ 2 activities of daily living, treatment with ≥ 5 drugs, active treatment for ≥ 3 diseases, recent emergency hospitalization, severe visual or hearing loss, cognitive impairment, Parkinson's disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), anaemia, or constitutional syndrome. Half of the patients will be randomly assigned to a 1-year DMP led by a case manager and the other half to usual care. The DMP consists of an educational programme for patients and caregivers on the management of HF, COPD (knowledge of the disease, smoking cessation, immunizations, use of inhaled medication, recognition of exacerbations), diabetes (knowledge of the disease, symptoms of hyperglycaemia and hypoglycaemia, self-adjustment of insulin, foot care) and depression (knowledge of the disease, diagnosis and treatment). It also includes close monitoring of the symptoms of decompensation and optimisation of treatment compliance. The main outcome variables are quality of life, hospital readmissions, and overall mortality during a 12-month follow-up. DISCUSSION: The physiological changes, lower life expectancy, comorbidity and low health literacy associated with aging may influence the effectiveness of DMPs in HF. The HF-Geriatrics study will provide direct evidence on the effect of a DMP in elderly patients with HF and high comorbidty, and will reduce the need to extrapolate the results of clinical trials in adults to elderly patients. TRIAL REGISTRATION: (ClinicalTrials.gov number, NCT01076465).

[Hypovitaminosis D in pediatric patients on renal replacement therapy]. / Hipovitaminosis D en pacientes pediátricos en terapia de sustitución renal.

BACKGROUND: Hypovitaminosis D has a high prevalence among patients with chronic kidney disease (CKD). AIM: To determine the prevalence of 25 hydroxy vitamin D (25(OH) D) insufficiency and deficiency in pediatric patients on dialysis and kidney transplantation. MATERIAL AND METHODS: Serum calcium and phosphorus, parathormone (PTH), alkaline phosphatases and 25 (OH)D were measured in 13 children on hemodialysis (HD), 18 on peritoneal dialysis (PD) and 53 that received an allograft (Tx), aged 9.8 ± 4.6 years (51% females). RESULTS: Fifty four percent of patients had height Z score less than -1.88. Patients on HD had the lowest values. The average time of replacement therapy was 2.9 ± 2.8 years. Mean 25(OH)D levels in all was 18.7 ± 10.7ng/ml (HD: 21 ± 16.8, PD: 18.9 ± 8.5, Tx: 18.1 ± 9.72 ng/ml). Eighty eight percent of patients had levels below 30 ng/ml. Mean of serum calcium was 9.5 ± 0.64 mg/dl, serum phosphorus 5.03 ± 1.02 mg/dl, calcium-phosphorus product 48 ± 11.8 mg/dl and alkaline phosphatases 300.5 ± 171.3 IU/L. Average PTH values in dialyzed and Tx patients were 724.6 ± 640.5 and 107.7 ± 56.2 pg/ml, respectively (p < 0.001). A positive correlation between 25 (OH) D and calcium levels among PD patients was observed (r = 0.490, p = 0.04). CONCLUSIONS: Hypovitaminosis D is highly prevalent among children on renal substitution therapy, regardless of the type of therapy used and the stage of renal failure.