Modeling and Optimization of the Adsorption of Cr (VI) in a Chitosan-Resole Aerogel Using Response Surface Methodology.

In this paper, a model for Cr (VI) removal and optimization was made using a novel aerogel material, chitosan-resole CS/R aerogel, where a freeze-drying and final thermal treatment was employed to fabricate the aerogel. This processing ensures a network structure and stability for the CS, despite the non-uniform ice growth promoted by this process. Morphological analysis indicated a successful aerogel elaboration process., FTIR spectroscopy corroborated the aerogel precursor's identity and ascertained chemical bonding after adsorption. Owing to the variability of formulations, the adsorption capacity was modeled and optimized using computational techniques. The response surface methodology (RSM), based on the Box-Behnken design using three levels, was used to calculate the best control parameters for the CS/R aerogel: the concentration at %vol (50-90%), the initial concentration of Cr (VI) (25-100 mg/L), and adsorption time (0.3-4 h). Analysis of variance (ANOVA) and 3D graphs reveal that the CS/R aerogel concentration and adsorption time are the main parameters that influence the initial concentration of CS/R aerogel metal-ion uptake. The developed model successfully describes the process with a correlation coefficient of R2 = 0.96 for the RSM. The model obtained was optimized to find the best material design proposal for Cr (VI) removal. Numerical optimization was used and showed superior Cr (VI) removal (94.4%) under conditions of a CS/R aerogel concentration of 87/13 %vol, with an initial concentration of Cr (VI) of 31 mg/L, and an adsorption time of 3.02 h. These results suggest that the proposed computational model can obtain an effective and viable model for CS material processing and for optimization of the uptake of this metal.

Circulating miR-499a and miR-125b as Potential Predictors of Left Ventricular Ejection Fraction Improvement after Cardiac Resynchronization Therapy.

Cardiac resynchronization therapy represents a therapeutic option for heart failure drug-refractory patients. However, due to the lack of success in 30% of the cases, there is a demand for an in-depth analysis of individual heterogeneity. In this study, we aimed to evaluate the prognostic value of circulating miRNA differences. Responder patients were defined by a composite endpoint of the presence of left ventricular reverse remodelling (a reduction ≥15% in telesystolic volume and an increment ≥10% in left ventricular ejection fraction). Circulating miRNAs signature was analysed at the time of the procedure and at a 6-month follow-up. An expression analysis showed, both at baseline and at follow-up, differences between responders and non-responders. Responders presented lower baseline expressions of miR-499, and at follow-up, downregulation of miR-125b-5p, both associated with a significant improvement in left ventricular ejection fraction. The miRNA profile differences showed a marked sensitivity to distinguish between responders and non-responders. Our data suggest that miRNA differences might contribute to prognostic stratification of patients undergoing cardiac resynchronization therapy and suggest that preimplant cardiac context as well as remodelling response are key to therapeutic success.

Phenols and Melanoidins as Natural Antioxidants in Beer. Structure, Reactivity and Antioxidant Activity.

Beer is one of the most consumed drinks around the world, containing a variety of compounds that offer both appreciated sensorial characteristics and health advantages. Important healthy compounds in beer are those with antioxidant properties that attenuate the content of free radicals produced as by-products in the human metabolism, exerting an appreciable effect against cancers or cardiovascular diseases. This work details a study of antioxidant compounds present in beer, focusing on the two main groups: phenols (including polyphenolic forms) and melanoidins, formed specifically during brewing as Maillard products. The fundaments of the most important methods to evaluate beer antioxidant activity, the main antioxidant compounds present in beer-especially those with healthy properties-and the new trends to increase beer antioxidant activity are also discussed.

Removal of Cu(II) by Fixed-Bed Columns Using Alg-Ch and Alg-ChS Hydrogel Beads: Effect of Operating Conditions on the Mass Transfer Zone.

The removal of Cu(II) ions from aqueous solutions at a pH of 5.0 was carried out using fixed-bed columns packed with alginate-chitosan (Alg-Ch) or alginate-chitosan sulfate (Alg-ChS) hydrogel beads. The effect of the initial Cu(II) concentration, flow rate, pH, and height of the column on the amount of Cu removed by the column at the breakpoint and at the exhaustion point is reported. The pH of the solution at the column's exit was initially higher than that at the entrance, and then decreased slowly. This pH increase was attributed to proton transfer from the aqueous solution to the amino and COO- groups of the hydrogel. The effect of operating conditions on the mass transfer zone (MTZ) and the length of the unused bed (HLUB) is reported. At the lower flow rate and lower Cu(II) concentration used, the MTZ was completely developed and the column operated efficiently; by increasing column height, the MTZ has a better opportunity to develop fully. Experimental data were fitted to the fixed-bed Thomas model using a non-linear regression analysis and a good correspondence between experimental and Thomas model curves was observed.

Early revascularization and long-term mortality in high-risk patients with non-ST-elevation myocardial infarction. The CARDIOCHUS-HUSJ registry.

INTRODUCTION AND OBJECTIVES: This study sought to analyze the association of early coronary angiography with all-cause mortality and cardiovascular mortality in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) using a large contemporary cohort of patients with NSTEACS from 2 Spanish tertiary hospitals. METHODS: This retrospective observational study included 5673 consecutive NSTEACS patients from 2 Spanish hospitals between 2005 and 2016. We performed propensity score matching to obtain a well-balanced subset of patients with the same probability of undergoing an early strategy, resulting in 3780 patients. Survival analyses were performed by Cox regression models once proportional risk test were verified. RESULTS: Among the study participants, only 2087 patients (40.9%) underwent early invasive coronary angiography. The median follow-up was 59.0 months [interquartile range, 25.0-80.0 months]. All-cause mortality was 19.0%, cardiovascular mortality was 12.8%, and 51.1% patients experienced at least 1 major cardiovascular adverse event in the follow-up. After propensity score matching, the early strategy was associated with significantly lower mortality (hazard ratio: 0.79; 95% confidence interval 0.62-0.98) in high-risk NSTEACS patients. The darly strategy showed a nonsignificant inverse tendency in patients with GRACE score <140. CONCLUSIONS: In high-risk (GRACE score≥ 140) NSTEACS patients in a contemporary real-world registry, early coronary angiography (first 24hours after hospital admission) may be associated with reduced all-cause mortality and cardiovascular mortality at long-term follow-up.

Prediction of major adverse cardiac, cerebrovascular events in patients with diabetes after acute coronary syndrome.

BACKGROUND AND OBJECTIVES: The risk of major adverse cardiac and cerebrovascular events following acute coronary syndrome is increased in people with diabetes. Predicting out-of-hospital outcomes upon follow-up remains difficult, and no simple, well-validated tools exist for this population at present. We aim to evaluate several factors in a competing risks model for actionable evaluation of the incidence of major adverse cardiac and cerebrovascular events in diabetic outpatients following acute coronary syndrome. METHODS: Retrospective analysis of consecutive patients admitted for acute coronary syndrome in two centres. A Fine-Gray competing risks model was adjusted to predict major adverse cardiac and cerebrovascular events and all-cause mortality. A point-based score is presented that is based on this model. RESULTS: Out of the 1400 patients, there were 783 (55.9%) with at least one major adverse cardiac and cerebrovascular event (417 deaths). Of them, 143 deaths were due to non-major adverse cardiac and cerebrovascular events. Predictive Fine-Gray models show that the 'PG-HACKER' risk factors (gender, age, peripheral arterial disease, left ventricle function, previous congestive heart failure, Killip class and optimal medical therapy) were associated to major adverse cardiac and cerebrovascular events. CONCLUSION: The PG-HACKER score is a simple and effective tool that is freely available and easily accessible to physicians and patients. The PG-HACKER score can predict major adverse cardiac and cerebrovascular events following acute coronary syndrome in patients with diabetes.

A prospective study of the clinical outcomes and prognosis associated with comorbid COPD in the atrial fibrillation population.

BACKGROUND: Patients with COPD are at higher risk of presenting with atrial fibrillation (AF). Information about clinical outcomes and optimal medical treatment of AF in the setting of COPD remains missing. We aimed to describe the prevalence of COPD in a sizeable cohort of real-world AF patients belonging to the same healthcare area and to examine the relationship between comorbid COPD and AF prognosis. METHODS: Prospective analysis performed in a specific healthcare area. Data were obtained from several sources within the "data warehouse of the Galician Healthcare Service" using multiple analytical tools. Statistical analyses were completed using SPSS 19 and STATA 14.0. RESULTS: A total of 7,990 (2.08%) patients with AF were registered throughout 2013 in our healthcare area (n=348,985). Mean age was 76.83±10.51 years and 937 (11.7%) presented with COPD. COPD patients had a higher mean CHA2DS2-VASc (4.21 vs 3.46; P=0.02) and received less beta-blocker and more digoxin therapy than those without COPD. During a mean follow-up of 707±103 days, 1,361 patients (17%) died. All-cause mortality was close to two fold higher in the COPD group (28.3% vs 15.5%; P<0.001). Independent predictive factors for all-cause mortality were age, heart failure, diabetes, previous thromboembolic event, dementia, COPD, and oral anticoagulation (OA). There were nonsignificant differences in thromboembolic events (1.7% vs 1.5%; P=0.7), but the rate of hemorrhagic events was significantly higher in the COPD group (3.3% vs 1.9%; P=0.004). Age, valvular AF, OA, and COPD were independent predictive factors for hemorrhagic events. In COPD patients, age, heart failure, vasculopathy, lack of OA, and lack of beta-blocker use were independent predictive factors for all-cause mortality. CONCLUSION: AF patients with COPD have a higher incidence of adverse events with significantly increased rates of all-cause mortality and hemorrhagic events than AF patients without COPD. However, comorbid COPD was not associated with differences in cardiovascular death or stroke rate. OA and beta-blocker treatment presented a risk reduction in mortality while digoxin use exerted a neutral effect.

Clinical profile and outcomes in octogenarians with atrial fibrillation: A community-based study in a specific European health care area.

BACKGROUND: Age increases risk of stroke and bleeding. Clinical trial data have had relatively low proportions of elderly subjects. We sought to study a Spanish population of octogenarians with atrial fibrillation (AF) by combining different sources of electronic clinical records from an area where all medical centres utilized electronic health record systems. METHODS: Data was derived from the Galician Healthcare Service information system. RESULTS: From 383,000 subjects, AF was coded in 7990 (2.08%), 3640 (45.6%) of whom were ≥80 and 4350 (54.4%)<80. All CHA2DS2-VASc's components were more prevalent in the elderly except for diabetes. Of those ≥80, 2178 (59.8%) were women. Mean CHA2DS2-VASc was 4.2±1.1. Distribution of CHA2DS2-VASc components varied between genders. 2600 (71.4%) were on oral anticoagulant (OA). During a median follow up of 696days (124.23), all-cause mortality was higher in ≥80 (1011/3640 (27.8%) vs 350/4350 (8.05%) (p<0.001). There were differences in rate of thromboembolic (TE) and haemorrhagic events (2.3% vs 0.9%, p<0.01 and 2.5% vs 1.7%, p=0.01 respectively). In octogenarian, differences between genders were observed with regard to TE, but not in haemorrhagic or all-cause mortality rates. Age, heart failure, non-valvular AF, dementia, and OA were independent predictors of all-cause mortality. In regard to TE, female gender, hypertension, previous TE and OA were independent predictive factors. CONCLUSIONS: Octogenarians with AF had very different characteristics and outcomes from their younger counterparts. These results also provide reassurance about the effectiveness of OA in preventing TE events and maintaining a reasonable haemorrhagic event rate in the extremely elderly.

Bagasse hydrolyzates from Agave tequilana as substrates for succinic acid production by Actinobacillus succinogenes in batch and repeated batch reactor.

The aim of this work was to obtain fermentable sugars by enzymatic or acid hydrolyses of Agave tequilana Weber bagasse in order to produce succinic acid with Actinobacillus succinogenes. Hydrolyses were carried out with mineral acids (sulfuric and hydrochloric acids) or a commercial cellulolytic enzyme, and were optimized statistically by a response surface methodology, having as factors the concentration of acid/enzyme and time of hydrolysis. The concentration of sugars obtained at optimal conditions for each hydrolysis were 21.7, 22.4y 19.8g/L for H2SO4, HCl and the enzymatic preparation respectively. Concerning succinic acid production, the enzymatic hydrolyzates resulted in the highest yield (0.446g/g) and productivity (0.57g/Lh) using A. succinogenes in a batch reactor system. Repeated batch fermentation with immobilized A. succinogenes in agar and with the enzymatic hydrolyzates resulted in a maximum concentration of succinic acid of 33.6g/L from 87.2g/L monosaccharides after 5 cycles in 40h, obtaining a productivity of 1.32g/Lh.

Coronariografía precoz y mortalidad a largo plazo en infarto agudo de miocardio de alto riesgo. Registro CARDIOCHUS-HUSJ / Early revascularization and long-term mortality in high-risk patients with non-ST-elevation myocardial infarction. The CARDIOCHUS-HUSJ registry

INTRODUCCIÓN Y OBJETIVOS: El objetivo de este estudio es analizar la asociación de la coronariografía precoz con la mortalidad por cualquier causa y la mortalidad cardiovascular en los pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST) utilizando una gran cohorte contemporánea de pacientes con SCASEST de 2 hospitales terciarios españoles. MÉTODOS: Este estudio observacional retrospectivo incluyó a 5.673 pacientes con SCASEST consecutivos de 2 hospitales españoles entre los años 2005 y 2016. Se emparejó por puntuación de propensión para obtener un subconjunto bien equilibrado de pacientes con la misma probabilidad de una coronariografía temprana, lo que dio como resultado 3.780 pacientes. RESULTADOS: Entre los participantes del estudio, se realizó una coronariografía precoz a solo 2.087 pacientes (40,9%). La mediana de seguimiento fue de 59,0 [intervalo intercuartílico, 25,0-80,0] meses. La mortalidad por cualquier causa fue del 19,0%; la mortalidad cardiovascular, del 12,8%, y el 51,1% de los pacientes sufrieron al menos 1 evento cardiovascular mayor (mortalidad, infarto agudo de miocardio, hospitalización por insuficiencia cardiaca o revascularización no planeada) en el seguimiento. Después de emparejar por puntuación de propensión, la revascularización temprana se asoció con una mortalidad significativamente menor (HR=0,79; IC95%, 0,62-0,98), en los pacientes con SCASEST de alto riesgo. La coronariografía precoz mostró una tendencia inversa no significativa en los pacientes con puntuación GRACE <140. CONCLUSIONES: En los pacientes con SCASEST de alto riesgo (puntuación GRACE ≥ 140) de un registro contemporáneo de la práctica clínica, la coronariografía temprana (las primeras 24 h tras el ingreso hospitalario) puede estar asociada con una reducción de la mortalidad por cualquier causa y la mortalidad cardiovascular en el seguimiento a largo plazo

INTRODUCTION AND OBJECTIVES: This study sought to analyze the association of early coronary angiography with all-cause mortality and cardiovascular mortality in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) using a large contemporary cohort of patients with NSTEACS from 2 Spanish tertiary hospitals. METHODS: This retrospective observational study included 5673 consecutive NSTEACS patients from 2 Spanish hospitals between 2005 and 2016. We performed propensity score matching to obtain a well-balanced subset of patients with the same probability of undergoing an early strategy, resulting in 3780 patients. Survival analyses were performed by Cox regression models once proportional risk test were verified. RESULTS: Among the study participants, only 2087 patients (40.9%) underwent early invasive coronary angiography. The median follow-up was 59.0 months [interquartile range, 25.0-80.0 months]. All-cause mortality was 19.0%, cardiovascular mortality was 12.8%, and 51.1% patients experienced at least 1 major cardiovascular adverse event in the follow-up. After propensity score matching, the early strategy was associated with significantly lower mortality (hazard ratio: 0.79; 95% confidence interval 0.62-0.98) in high-risk NSTEACS patients. The early strategy showed a nonsignificant inverse tendency in patients with GRACE score <140. CONCLUSIONS: In high-risk (GRACE score ≥ 140) NSTEACS patients in a contemporary real-world registry, early coronary angiography (first 24 hours after hospital admission) may be associated with reduced all- cause mortality and cardiovascular mortality at long-term follow-up