Wrinkled titanium nitride nanocomposite for robust bendable electrodes.

Electrical contacts and interconnections are critical components for all electronic devices. Bendable electrodes with enhanced electro-mechanical properties are highly desirable to develop innovative wearable electronic devices. Herein we report on a fabrication method for robust bendable coatings based on titanium nitride (TiN) thin films and silver nanowires (Ag NWs). TiN and TiN-AgNWs nanocomposites were deposited on polyethylene terephthalate (PET) substrates using a plasma enhanced pulsed laser deposition (PLD) technique. The resulting TiN coatings exhibit excellent adhesion to PET and their sheet resistance can be tuned using a dual frequency PLD process and further decreased by incorporating Ag NWs into the TiN layers. Sample sheet resistance was decreased down to values as low as [Formula: see text] corresponding to the formation of TiN-AgNWs nanocomposites. The electro-mechanical robustness of TiN based coatings were evaluated by four-probe resistance measurements in situ under cyclic bending tests. We show that the TiNAgNWs nanocomposites surpass both ITO and Ag NWs coatings in terms of mechanical robustness and electrical conductivity respectively. These nanocomposites withstand high strain fatigue loading up to ϵ = 2.6%, keeping R S below 5 Ω/□. The data demonstrates that the incorporation of Ag NWs in TiN coatings improve the mechanical robustness, limiting the crack growth and propagation, with low optical transmittance decrease (≈11%). These results indicate that Ag NWs based nanocomposites are attractive materials for flexible electronic devices.

Mechanistic interrogation of mutation-independent disease modulators of RDEB identifies the small leucine-rich proteoglycan PRELP as a TGF-ß antagonist and inhibitor of fibrosis.

Recessive dystrophic epidermolysis bullosa (RDEB) is a genetic extracellular matrix disease caused by deficiency in type VII collagen (Col VII). The disease manifests with devastating mucocutaneous fragility leading to progressive fibrosis and metastatic squamous cell carcinomas. Although Col VII abundance is considered the main predictor of symptom course, previous studies have revealed the existence of mutation-independent mechanisms that control disease progression. Here, to investigate and validate new molecular modifiers of wound healing and fibrosis in a natural human setting, and toward development of disease-modulating treatment of RDEB, we performed gene expression profiling of primary fibroblast from RDEB siblings with marked phenotypic variations, despite having equal COL7A1 genotype. Gene enrichment analysis suggested that severe RDEB was associated with enhanced response to TGF-ß stimulus, oxidoreductase activity, and cell contraction. Consistently, we found an increased response to TGF-ß, higher levels of basal and induced reactive oxygen species (ROS), and greater contractile ability in collagen lattices in RDEB fibroblasts (RDEBFs) from donors with severe RDEB vs mild RDEB. Treatment with antioxidants allowed a reduction of the pro-fibrotic and contractile phenotype. Importantly, our analyses revealed higher expression and deposition in skin of the relatively uncharacterized small leucine-rich extracellular proteoglycan PRELP/prolargin associated with milder RDEB manifestations. Mechanistic investigations showed that PRELP effectively attenuated fibroblasts' response to TGF-ß1 stimulus and cell contractile capacity. Moreover, PRELP overexpression in RDEBFs enhanced RDEB keratinocyte attachment to fibroblast-derived extracellular matrix in the absence of Col VII. Our results highlight the clinical relevance of pro-oxidant status and hyper-responsiveness to TGF-ß in RDEB severity and progression. Of note, our study also reveals PRELP as a novel and natural TGF-ß antagonist with a likely dermo-epidermal pro-adhesive capacity.

Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program.

In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyzes, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.

The in vitro effect of manuka honeys on growth and adherence of oral bacteria.

Honey has been used since ancient times and more recently, for the healing of wounds and against infectious diseases. The aim of our study was to investigate the effect of two manuka honeys showing different potencies of their antibacterial activity, on potentially pathogenic oral bacteria. The antimicrobial activity was examined by determining the MIC and MBC using the macro dilution broth technique. The effect on the adherence was tested on growing cells of Streptococcus mutans on a glass surface and on a multi-species biofilm grown on saliva-coated hydroxyapatite discs. As expected, the antibacterial activity of manuka 1 (with higher potency of antibacterial activity) was the most important. The two tested honeys weakly inhibited the adherence of S.mutans cells to a glass surface at sub-MIC concentration. Manuka 1 showed a total inhibition of multi-species biofilm at the concentration of 200 µg/ml manuka 2 inhibited biofilm formation weakly at the concentration of 200 µg/ml but firmly at the concentration of 500 µg/ml. Our findings suggest that manuka honeys might be able to reduce oral pathogens within dental plaque. These two honeys appear to be able to control dental biofilm deposit.

Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program. / Recomendaciones de la Sociedad Española de Cirugía Torácica y de la Sección de Cardiotorácica y Cirugía Vascular de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor, para los pacientes sometidos a cirugía pulmonar incluidos en un programa de recuperación intensificada.

In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyses, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.

Chitosan mediated gold nanoparticles against pathogenic bacteria, fungal strains and MCF-7 cancer cells.

In the present study, we report cytotoxic and antimicrobial potential of gold nanoparticles (Au NPs) synthesized using chitosan derived from squilla shell wastes. Here we adopted ecofriendly approach for the synthesis of Au NPs and characterized them using UV-visible spectroscopy, Fourier transform infrared spectroscopy, X-ray diffraction, atomic force microscopy, transmission electron microscopy (TEM) and dynamic light scattering (DLS) methods. The UV-visible spectroscopic analysis revealed an absorption peak at 529 nm, which represents the Surface Plasmon Resonance of Au NPs. TEM analysis showed that the biosynthesized Au NPs were spherical in shape with an average size of 80 to 82 nm. Interestingly, the biosynthesized Au NPs showed antimicrobial activity against selected Gram-positive and negative bacterial isolates and also showed activity against fungal pathogens. Further, the cytotoxic effect of the synthesized Au NPs against MCF-7 cell lines was assessed by MTT assay with IC50 value of 250 µg mL-1. In addition, double staining of treated MCF-7 cells with acridine orange and ethidium bromide shows that the Au NPs exert apoptosis mediated cytotoxicity.

Analysis of lung transplant recipients surviving beyond 5 years.

INTRODUCTION: We started lung transplantation (LT) in October 1993 and review the status of recipients who have survived beyond 5 years. METHODS: A retrospective review of patients undergoing LT from October 1993 to October 1998 included pulmonary function data, incidence of bronchiolitis obliterans syndrome (BOS), functional status, and survival. RESULTS: Of 73 transplantations 41 (56%) patients have survived beyond 5 years (study group), including 23 men and 18 women of age 33.2 +/- 15.6 years. Indications for LT were as follows: cystic fibrosis (n = 16), emphysema (n = 13), pulmonary fibrosis (n = 8), and other (n = 4). Actuarial survival at 5, 7, and 9 years was 56%, 53%, and 43%, respectively. Freedom from BOS was 63%, 56%, and 50% at 5, 7, and 9 years, respectively. The median percent predicted FEV1 was 67%, 56%, and 56%, respectively. Also, 79% of recipients had no limitations in their daily activities; 65% were active and working. Only 5% of patients showed some degree of limitation at 5 years posttransplantation. When survivors beyond 5 years were compared with nonsurvivors beyond 5 years, differences were observed: nonsurvivors more frequently required bypass (P = .01), experienced longer postoperative intubation times (P = .01), and exhibited lower PaO2 at 12 months posttransplantation (P < .01). CONCLUSION: Our data show good survival rates among patients surviving beyond 5 years after LT, with a moderate incidence of BOS at 9 years posttransplantation. Despite the incidence of BOS, these patients have good pulmonary function and activity status.

Pulmonary tailoring and lobar transplantation to overcome size disparities in lung transplantation.

Size matching between donors and recipients represents one of the organ distribution criteria widely accepted by lung transplant teams. However, in some cases it is not possible to allocate a donor to the corresponding size-compatible recipient. To avoid possible complications derived from the implantation of oversized lungs into smaller recipients, surgical procedures such as pulmonary tailoring and lobar transplantation have been advocated. We review our experience in 13 patients undergoing volume reduction of the lung graft at the time of transplantation, either by nonanatomical lung volume reduction or by lobar transplantation. There were no significant differences between lung-downsized patients and standard lung transplantation patients in terms of donor characteristics, surgical and postoperative complications, functional outcome, and survival. We conclude that downsizing the lung graft either by nonanatomical resection or lobar transplantation is safe and reliable to overcome size disparities between donor and recipients, with no additional morbidity and with similar early and midterm outcomes to those in standard lung transplants.

[Value of transesophageal echocardiography in the assessment of blunt chest trauma: correlation with electrocardiogram, heart enzymes, and transthoracic echocardiogram]. / Valor da ecocardiografia transesofágica na avaliação de doentes com traumatismo torácico fechado: correlação com o electrocardiograma, enzimas cardíacas e ecocardiograma transtorácico.

OBJECTIVE: To asses the feasibility, usefulness and clinical rentability of the transesophageal echocardiography (TEE) in the evaluation of patients suffering a severe blunt chest trauma as well as to correlate the TEE findings with those provided by the conventional electrocardiogram (ECG), cardiac isoenzymes assay and transthoracic echocardiography (TTE). DESIGN: Prospective study using ECG, blood cardiac enzymes assay, TTE and TEE. SETTING: Intensive care unit of a general hospital. PATIENTS: We studied 34 patients admitted with blunt chest trauma and suspected cardiac contusion in spite of the existence of other traumatic injuries in some of them. There were 23 (67.6%) males and 11 females, with a mean age of 37.1 +/- 19.4 years (range: 16-69 years). MATERIAL AND METHODS: Patients with a previous history of cardiovascular or chronic pulmonary disease, cardiac arrest upon admission or positive cocaine or amphetamine levels in the urine were excluded from the study. Suspected cardiac contusion was established by clinical data, electrocardiographic findings, enzymes blood values (CPK-total and MB-fraction) and TTE findings. Additionally, a TEE was performed in each patient. Patients were stratified into two groups according to the TEE findings: Group A patients had signs compatible with cardiac contusion and in Group B patients there was a lack of evidence to substantiate this diagnosis. Those tests were evaluated in respect to their accuracy in the diagnosis of cardiac contusion when compared to transesophageal echocardiography and TEE findings were compared, whenever possible, to surgical or necropsic findings. RESULTS: We found TEE signs of cardiac injury in 22 (64.7%) patients and a wide spectrum of traumatic cardiac abnormalities were identified. TEE signs of ventricular injury were found in 15 pts of Group A (68.2%) being the right ventricle the most frequent affected. There were also two cases of mitral leaflet rupture, one case of tricuspid valve prolapse (with severe tricuspid regurgitation and associated with right ventricle wall motion abnormalities) and seven cases of pericardial effusion as well as one case of thoracic aortic dissection. In every patient submitted to cardiothoracic surgery or necropsy the TEE findings were confirmed. TEE provided significant information, sometimes crucial, to the patient evaluation and management, it was performed without any difficulty and it doesn't carried out any related complication. TTE was technically suboptimal in 53% and fail to demonstrate many cases of cardiac contusion and the thoracic aorta lesion, being the number of cardiovascular injuries demonstrated by TEE significantly higher (p = 0.029). No statistically significant difference was found between the number of patients with either an abnormal ECG or high values of CPK-MB in each group. Neither clinical findings, cardiac enzymes values, serial ECG's nor TTE predicted all the patients who had traumatic cardiac injury and those would subsequently developed complications related to cardiac contusion. CONCLUSIONS: A severe blunt chest trauma frequently results in cardiac injury. The ECG and the CPK-MB measurements appears both to be fairly sensitive and specific tests in the cardiac contusion diagnosis. TTE has shown to have important limitations in these patients, thus not allowing neither a complete echo evaluation nor a reliable one. TEE plays an important role in the evaluation and management of this type of patients providing rapid diagnostic information and being of high value in the rule out cardiac contusion as well as in the establishment of a specific diagnosis of cardiac and/or thoracic aorta injuries with a consequent better assessment and treatment strategy in these patients.

[Epileptic syndromes which show continuous spike and wake complexes during slow wave sleep]. / Síndromes epilépticos que cursan con complejos punta-onda continuos durante el sueño lento.

INTRODUCTION AND OBJECTIVE: The association of cognitive and/or behavioral disturbances, epileptic seizures and continuous discharges spike-waves during slow sleep in the EEG, has been described in three epileptic syndromes: continuous spike-wave during slow sleep syndrome (CSWS), Landau-Kleffner syndrome (LKS) or acquired epileptic aphasia, and atypical benign partial epilepsy of childhood (ABPE). MATERIAL AND METHODS: We report 13 patients; two of these have been diagnosed of CSWS. four of LKS and seven of ABPE, according to the definition criteria. RESULTS: The main clinical features in each patient are presented here. In all patients, continuous spike-wave discharges were observed for more than > 80% of the total sleep period at some time during the course of the illness. There are many similarities at the age of onset, the occurrence of several types of seizures, the evolution and the electroencephalographic findings in awake state and sleep. CONCLUSIONS: It suggests that the CSWS, LKS and ABPE have probably the same pathophysiology and that they are the severe, moderate and benign forms of a single epileptic syndrome, age-related, with continuous spike waves and various neuropsychological and behavioral disturbances. The neuropsychological manifestations depend probably on the localization of the original epileptic focus.

Honey-induced macrophage stimulation: AP-1 and NF-κB activation and cytokine production are unrelated to LPS content of honey.

Honey is well known for its wound healing properties although the cellular and molecular mechanisms underlying honey-stimulated healing process are still poorly understood. The present study was intended to characterize the stimulation of Raw 264.7 murine macrophages in response to thyme honey. Honey induces significant increase in PGE2 production, and overexpression of both COX-2 and TNF-α (p<0.001). This increase was concomitant with overexpression and activation of the AP-1 and NF-κB transcription factor subunits. The small LPS content of honey could not, by itself, account for the reported observations. These results suggest that other thyme honey components participate in the stimulation of cytokine production required for effective wound healing process.

Monitoring in vivo load transmission through an external fixator.

This work presents a portable non-invasive external fixator to assess and monitor fracture healing in real time. To evaluate the potential of this fixator, a transverse osteotomy was performed in the tibia of six adult sheep (mean age 3+/-0.5 years and weight 63+/-5 kg). The fractures were stabilized by a specially designed unilateral external fixator, which was instrumented by means of a set of strain gauges. Strains in the external surface of the fixator were monitored during all the healing process. A wireless, remote monitoring of the implant was developed through a specially designed external telemetric device. The strain gauges were arranged in two different half-bridge Wheatstone configurations, allowing easy post-processing of the signal. Thus, bending loads were measured in two planes of the external fixator acting as a load cell. The load through the fixator was evaluated for the gait cycle during all the healing process. Full weight bearing of the injured leg was observed from the beginning. The load transmission mechanism in the fixator was quite similar in all operated tibias and radiographic images showed a successful healing in all animals. Although the fixator has only been tested in an animal model, after further testing this system may have clinical potential.

[Sleep apnea in a child with adenotonsillar hypertrophy (author's transl)]. / Hipoventilación durante el sueño en un niño con hipertrofia amigdaloadenoidea crónica.

A three year old with sleep apnea due to adenotonsillar hypertrophy is presented. The picture improved after treatment with antibiotics and corticosteroids, and disappeared after adenotonsillectomy. The symptomatology is studied in relation to primary alveolar hypoventilation and the "sudden death" syndrome in infants. The need of an early diagnosis is emphasized to avoid onset of an irreversible "cor pulmonale". It is suggested that aside from a probable predisposing "central" and constitutional factor in children with this syndrome, apparently there are heterogeneous electroencephalographic sleep patterns.

[Effect of tolbutamide on plasmatic insulin and glucose in children treated with diphenylhydantoin (author's transl)]. / Respuesta de la insulina y glucosa plasmáticas a la tolbutamida, en niños tratados con difenilhidantoína

The response of the serum glucose and insulin to tolbutamide in six epileptic children before and after one month treatment with DH are studied. A significant increase of the glycemia after treatment with DH is observed having insulin values no statistically significant modification.

[Melitococcal hepatic encephalopathy]. / Encéphalopathie hépatique mélitococcique.

A 5 year old child with brucellosis is described who developed severe liver disease with neuropsychiatric signs and electroencephalographic changes.