Selective Focal Laser Therapy as the Primary Treatment for Exudative Perifoveal Vascular Anomalous Complex (ePVAC): Case Series and Literature Review.

Perifoveal anomalous exudative vascular complex (PEVAC) was first described in 2011. Since then, individual clinical cases and a couple of case series have been published, and their characteristics have been studied in multi-modal images. To date, there is no consensus on its treatment. Initially, it was thought that PEVACs could be left to spontaneous evolution because they presented a slow progression. But it has been shown that the growth of the lesion covers a spectrum from non-exudative lesions to PEVAC with vision impairment over time. We present an updated bibliographic review of this pathology. We explain the changes in the diagnostic criteria that have been undergone. And we focus the discussion on selective treatment with focal laser, which has shown an excellent anatomical response and visual improvement or stabilization in the cases described and in our series of three patients systematically treated with focal laser. [Ophthalmic Surg Lasers Imaging Retina 2023;54:43-49.].

Bioaccumulation/bioconcentration of pharmaceutical active compounds in aquatic organisms: Assessment and factors database.

There is increasing evidence that the presence of certain pharmaceuticals in the environment leads to biota exposure and constitute a potential risk for ecosystems. Bioaccumulation is an essential focus of risk assessment to evaluate at what degree emerging contaminants are a hazard both to the environment and the individuals that inhabit it. The main goals of the present review are 1) to summarize and describe the research and factors that should be taken into account in the evaluation of bioaccumulation of pharmaceuticals in aquatic organisms; and 2) to provide a database and a critical review of the bioaccumulation/bioconcentration factors (BAF or BCF) of these compounds in organisms of different trophic levels. Most studies fall into one of two categories: laboratory-scale absorption and purification tests or field studies and, to a lesser extent, large-scale, semi-natural system tests. Although in the last 5 years there has been considerable progress in this field, especially in species of fish and molluscs, research is still limited on other aquatic species like crustaceans or algae. This revision includes >230 bioconcentration factors (BCF) and >530 bioaccumulation factors (BAF), determined for 113 pharmaceuticals. The most commonly studied is the antidepressant group, followed by diclofenac and carbamazepine. There is currently no reported accumulation data on certain compounds, such as anti-cancer drugs. BCFs are highly influenced by experimental factors (notably the exposure level, time or temperature). Field BAFs are superior to laboratory BCFs, highlighting the importance of field studies for reliable assessments and in true environmental conditions. BAF data appears to be organ, species and compound-specific. The potential impact on food web transfer is also considered. Among different aquatic species, lower trophic levels and benthic organisms exhibit relatively higher uptake of these compounds.

Comparison of Different Techniques for the Determination of Platinized Cytostatic Drugs in Urine Samples.

Platinum-based cytostatic drugs are one of the most widely used cancer treatments. They are excreted via the urinary tract and can reach the environment through wastewater, posing a risk to human health due to their side effects. Four identification and quantification techniques, including liquid chromatography (LC) separation coupled to (i) a diode array ultraviolet (UV(DAD)) (ii), mass spectrometer in single ion monitoring mode (LC-MS) and (iii) multiple reaction monitoring mode (LC-MS/MS) and (iv) derivatization with diethyldithiocarbamate prior to LC-MS/MS analysis, have been optimized and compared for the multiresidue determination of main platinized cytostatic drugs (cisplatin, carboplatin, and oxaliplatin) in urine samples. Parameters that affect the efficiency of the chromatographic separation and analytical determination of different methods (column, mobile phase, wavelength, precursor ions, fragmentor, and product ions) were optimized. Analytical features, such as matrix effect, sensitivity, precision, selectivity, and linearity, were calculated. In terms of selectivity, the derivatization technique was discarded since it was only applicable to the platinated sum. A high dilution of the sample with LC-UV(DAD) was needed to reduce the matrix effect. Overall, the LC-MS/MS method presented the best analytical features (% RSD ≤ 12.8%, R2 ≥ 0.991, or method-detection limits between 0.01-1 µg mL-1). The selected method was applied to the quantification of platinized cytostatic drugs in hospital urine samples from oncologic patients.

Postoperative Packing of Perianal Abscess Cavities (PPAC2): randomized clinical trial.

BACKGROUND: Perianal abscess is common. Traditionally, postoperative perianal abscess cavities are managed with internal wound packing, a practice not supported by evidence. The aim of this randomized clinical trial (RCT) was to assess if non-packing is less painful and if it is associated with adverse outcomes. METHODS: The Postoperative Packing of Perianal Abscess Cavities (PPAC2) trial was a multicentre, RCT (two-group parallel design) of adult participants admitted to an NHS hospital for incision and drainage of a primary perianal abscess. Participants were randomized 1:1 (via an online system) to receive continued postoperative wound packing or non-packing. Blinded data were collected via symptom diaries, telephone, and clinics over 6 months. The objective was to determine whether non-packing of perianal abscess cavities is less painful than packing, without an increase in perianal fistula or abscess recurrence. The primary outcome was pain (mean maximum pain score on a 100-point visual analogue scale). RESULTS: Between February 2018 and March 2020, 433 participants (mean age 42 years) were randomized across 50 sites. Two hundred and thirteen participants allocated to packing reported higher pain scores than 220 allocated to non-packing (38.2 versus 28.2, mean difference 9.9; P < 0.0001). The occurrence of fistula-in-ano was low in both groups: 32/213 (15 per cent) in the packing group and 24/220 (11 per cent) in the non-packing group (OR 0.69, 95 per cent c.i. 0.39 to 1.22; P = 0.20). The proportion of patients with abscess recurrence was also low: 13/223 (6 per cent) in the non-packing group and 7/213 (3 per cent) in the packing group (OR 1.85, 95 per cent c.i. 0.72 to 4.73; P = 0.20). CONCLUSION: Avoiding abscess cavity packing is less painful without a negative morbidity risk. REGISTRATION NUMBER: ISRCTN93273484 (https://www.isrctn.com/ISRCTN93273484). REGISTRATION NUMBER: NCT03315169 (http://clinicaltrials.gov).

Perianal abscess is a common, painful condition due to infection and swelling around the anus caused by blockage of the anal glands. The treatment of perianal abscess has stayed the same for over 50 years. An operation is performed under general anaesthetic to cut the skin and drain the infection. This is followed by continued internal dressing (packing) of the remaining cavity (hole) until the skin has healed over. Packing changes are needed multiple times a week for several weeks. Packing is the accepted treatment as it is believed to reduce the chance of the abscess coming back, and also reduces the chance of perianal fistula forming. There are no medical studies to support this idea. Perianal fistula (an abnormal passage between the skin around the anus, and the inside of the anal canal or rectum) is a long-term condition, which causes pain, and pus (and sometimes faeces) discharge, and often needs another operation (or multiple operations) to fix it. This trial was performed to demonstrate if no packing of a perianal abscess would result in a reduction of pain, with no increase in unwanted abscess recurrences and fistulas, in comparison to the standard treatment of packing. The trial recruited 433 people, who were randomly chosen to enter one of two groups; one to have their wound packed and the other to have no packing of the wound. After being discharged from hospital following surgery, the patients attended or were visited by a community nurse for the dressing to be changed or wound packed. Each patient provided information on pain from their wound, including worst pain each day and pain before, during, and after the changing of their dressing or packing. This and other information was gathered for the first 10 days after surgery and periodically until 6 months after surgery. The no-packing group experienced much less pain than the packing group. There was no difference in abscess recurrence and fistula formation between the non-packing and packing groups. The findings demonstrate that no packing of perianal abscess wounds after drainage operation is the best treatment.

Brain Cell Senescence: A New Therapeutic Target for the Acute Treatment of Ischemic Stroke.

Aging is a major risk factor for cerebral infarction. Since cellular senescence is intrinsic to aging, we postulated that stroke-induced cellular senescence might contribute to neural dysfunction. Adult male Wistar rats underwent 60-minute middle cerebral artery occlusion and were grouped according to 3 reperfusion times: 24 hours, 3, and 7 days. The major biomarkers of senescence: 1) accumulation of the lysosomal pigment, lipofuscin; 2) expression of the cell cycle arrest markers p21, p53, and p16INK4a; and 3) expression of the senescence-associated secretory phenotype cytokines interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), and interleukin-1ß (IL-1ß) were investigated in brain samples. Lipofuscin accumulation was scarce at the initial stage of brain damage (24 hours), but progressively increased until it reached massive distribution at 7 days post-ischemia. Lipofuscin granules (aggresomes) were mainly confined to the infarcted areas, that is parietal cortex and adjacent caudate-putamen, which were equally affected. The expression of p21, p53, and p16INK4a, and that of IL-6, TNF-α, and IL-1ß, was significantly higher in the ischemic hemisphere than in the non-ischemic hemisphere. These data indicate that brain cell senescence develops during acute ischemic infarction and suggest that the acute treatment of ischemic stroke might be enhanced using senolytic drugs.

SifR is an Rrf2-family quinone sensor associated with catechol iron uptake in Streptococcus pneumoniae D39.

Streptococcus pneumoniae (pneumococcus) is a Gram-positive commensal and human respiratory pathogen. How this bacterium satisfies its nutritional iron (Fe) requirement in the context of endogenously produced hydrogen peroxide is not well understood. Here, we characterize a novel virulence-associated Rrf2-family transcriptional repressor that we term SifR (streptococcal IscR-like family transcriptional repressor) encoded by spd_1448 and conserved in Streptococci. Global transcriptomic analysis of a ΔsifR strain defines the SifR regulon as genes encoding a candidate catechol dioxygenase CatE, an uncharacterized oxidoreductase YwnB, a candidate flavin-dependent ferric reductase YhdA, a candidate heme-based ferric reductase domain-containing protein and the Piu (pneumococcus iron uptake) Fe transporter (piuBCDA). Previous work established that membrane-anchored PiuA binds FeIII-bis-catechol or monocatechol complexes with high affinity, including the human catecholamine stress hormone, norepinephrine. We demonstrate that SifR senses quinone via a single conserved cysteine that represses its regulon when in the reduced form. Upon reaction with catechol-derived quinones, we show that SifR dissociates from the DNA leading to regulon derepression, allowing the pneumococcus to access a catechol-derived source of Fe while minimizing reactive electrophile stress induced by quinones. Consistent with this model, we show that CatE is an FeII-dependent 2,3-catechol dioxygenase with broad substrate specificity, YwnB is an NAD(P)H-dependent quinone reductase capable of reducing the oxidized and cyclized norepinephrine, adrenochrome, and YhdA is capable of reducing a number of FeIII complexes, including PiuA-binding transport substrates. These findings are consistent with a model where FeIII-catechol complexes serve as significant nutritional Fe sources in the host.

Perpetual past: psychoanalytic effects on the temporal logic in a case of psychosis / Passado perpétuo: efeitos psicanalíticos da lógica temporal em um caso de psicose

ABSTRACT: In this paper, our aim is to study a specific clinical case taking the temporal dimension as the main angle of analysis. We explore the effects of psychoanalysis on time's representation of a patient showing psychotic symptoms. We analyze the different moments of the therapy that made possible an original integration of the temporal dimension by working on the local coordinates of the therapeutic setting. The "subjective effects" that guided the cure are stipulated and articulated to the different interventions to show the logical foundation of the psychoanalytic clinical practice in this case.

Resumo: Neste artigo, apresentamos um caso clínico especial considerando a dimensão temporal como perspectiva privilegiada. Examinamos os efeitos da psicanálise na representação do tempo de um paciente que apresenta uma sintomatologia psicótica. A partir de um trabalho centrado nas coordenadas locais do quadro terapêutico, analisamos os diferentes momentos da terapia ligados a uma nova integração da dimensão temporal. Consideramos os "efeitos subjetivos" específicos que orientam o tratamento como ligados às diversas intervenções, a fim de destacar os fundamentos lógicos da prática psicanalítica neste caso.

Management of MDA-5 antibody-positive dermatomyositis with interstitial lung disease-an Auckland case series.

OBJECTIVE: The aim was to present our experience of managing six cases of anti-melanoma differentiation-associated gene 5 (anti-MDA-5) DM with associated interstitial lung disease (ILD), presenting between June 2017 and October 2020. METHODS: The electronic notes were reviewed for six patients being followed up by the Rheumatology service at Auckland District Health Board. Three patients were initially diagnosed and treated in neighbouring Counties Manukau District Health Board and later transferred to Auckland District Health Board. All had different initial treating clinicians at a time before any predefined treatment algorithm. Emphasis was placed on initial diagnosis and treatment, subsequent disease activity and changes in management. Local management was compared retrospectively with existing evidence relating to the treatment of anti-MDA-5 DM with ILD. Ethical approval was not obtained, according to the New Zealand Health and Disability Ethics Committee exemption for audits and related activities. RESULTS: Six patients with a variety of clinical presentations were identified appropriately as having anti-MDA-5 DM with ILD. They were commenced on different immunosuppressive regimens, with treatment adjusted according to response and on-going disease activity. Four have achieved clinical and biochemical remission, a fifth has improving active disease, and the sixth is in the early stages of their illness. CONCLUSION: Anti-MDA-5 DM is commonly associated with ILD. This can be rapidly progressive, with a poor prognosis in spite of treatment, particularly among Asian patients. Disease activity can seemingly be monitored with serum ferritin. The most effective management of this condition remains poorly researched; however, increasing retrospective evidence favours early aggressive multi-agent immunosuppression and a low threshold for escalation of therapy.

The risk and predictors of mortality in octogenarians undergoing emergency laparotomy: a multicentre retrospective cohort study.

OBJECTIVES: This study aims to evaluate the risk of postoperative mortality in octogenarians undergoing emergency laparotomy. METHODS: In compliance with STROCSS guideline for observational studies, we conducted a multicentre retrospective cohort study. All consecutive patients aged over 80 with acute abdominal pathology requiring emergency laparotomy between April 2014 and August 2019 were considered eligible for inclusion. The primary outcome measure was 30-day postoperative mortality, and the secondary outcome measures were in-hospital mortality and 1-year mortality. Statistical analyses included simple descriptive statistics, binary logistic regression analyses, and Kaplan-Meier survival statistics. RESULTS: A total of 523 octogenarians were eligible for inclusion. Emergency laparotomy in octogenarians was associated with 21.8% (95% CI 18.3-25.6%) 30-day postoperative mortality, 22.6% (95% CI 19.0-26.4%) in-hospital mortality, and 40.2% (95% CI 35.9-44.5%) 1-year mortality. Binary logistic regression analysis identified ASA status (OR, 2.49; 95% CI 1.82-3.38, P < 0.0001) and peritoneal contamination (OR, 2.00; 95% CI 1.30-3.08, P = 0.002) as predictors of 30-day postoperative mortality. The ASA status (OR, 1.92; 95% CI 1.50-2.46, P < 0.0001), peritoneal contamination (OR, 1.57; 95% CI 1.07-2.48, P = 0.020), and presence of malignancy (OR, 2.06; 95% CI 1.36-3.10, P = 0.001) were predictors of 1-year mortality. Log-rank test showed significant difference in postoperative survival rates among patients with different ASA status (P < 0.0001) and between patients with and without peritoneal contamination (P = 0.0011). CONCLUSIONS: Emergency laparotomies in patients older than 80 years with ASA status more than 3 in the presence of peritoneal contamination carry a high risk of immediate postoperative and 1-year mortality. This should be taken into account in communications with patients and their relatives, consent process, and multidisciplinary decision-making process for operative or non-operative management of such patients.

Uric Acid Neuroprotection Associated to IL-6/STAT3 Signaling Pathway Activation in Rat Ischemic Stroke.

Despite the promising neuroprotective effects of uric acid (UA) in acute ischemic stroke, the seemingly pleiotropic underlying mechanisms are not completely understood. Recent evidence points to transcription factors as UA targets. To gain insight into the UA mechanism of action, we investigated its effects on pertinent biomarkers for the most relevant features of ischemic stroke pathophysiology: (1) oxidative stress (antioxidant enzyme mRNAs and MDA), (2) neuroinflammation (cytokine and Socs3 mRNAs, STAT3, NF-κB p65, and reactive microglia), (3) brain swelling (Vegfa, Mmp9, and Timp1 mRNAs), and (4) apoptotic cell death (Bcl-2, Bax, caspase-3, and TUNEL-positive cells). Adult male Wistar rats underwent intraluminal filament transient middle cerebral artery occlusion (tMCAO) and received UA (16 mg/kg) or vehicle (Locke's buffer) i.v. at 20 min reperfusion. The outcome measures were neurofunctional deficit, infarct, and edema. UA treatment reduced cortical infarct and brain edema, as well as neurofunctional impairment. In brain cortex, increased UA: (1) reduced tMCAO-induced increases in Vegfa and Mmp9/Timp1 ratio expressions; (2) induced Sod2 and Cat expressions and reduced MDA levels; (3) induced Il6 expression, upregulated STAT3 and NF-κB p65 phosphorylation, induced Socs3 expression, and inhibited microglia activation; and (4) ameliorated the Bax/Bcl-2 ratio and induced a reduction in caspase-3 cleavage as well as in TUNEL-positive cell counts. In conclusion, the mechanism for morphological and functional neuroprotection by UA in ischemic stroke is multifaceted, since it is associated to activation of the IL-6/STAT3 pathway, attenuation of edematogenic VEGF-A/MMP-9 signaling, and modulation of relevant mediators of oxidative stress, neuroinflammation, and apoptotic cell death.

Periprocedural Direct Oral Anticoagulant Management: The RA-ACOD Prospective, Multicenter Real-World Registry.

Introduction There is scarce real-world experience regarding direct oral anticoagulants (DOACs) perioperative management. No study before has linked bridging therapy or DOAC-free time (pre-plus postoperative time without DOAC) with outcome. The aim of this study was to investigate real-world management and outcomes. Methods RA-ACOD is a prospective, observational, multicenter registry of adult patients on DOAC treatment requiring surgery. Primary outcomes were thrombotic and hemorrhagic complications. Follow-up was immediate postoperative (24-48 hours) and 30 days. Statistics were performed using a univariate and multivariate analysis. Data are presented as odds ratios (ORs [95% confidence interval]). Results From 26 Spanish hospitals, 901 patients were analyzed (53.5% major surgeries): 322 on apixaban, 304 on rivaroxaban, 267 on dabigatran, 8 on edoxaban. Fourteen (1.6%) patients suffered a thrombotic event, related to preoperative DOAC withdrawal (OR: 1.57 [1.03-2.4]) and DOAC-free time longer than 6 days (OR: 5.42 [1.18-26]). Minor bleeding events were described in 76 (8.4%) patients, with higher incidence for dabigatran (12.7%) versus other DOACs (6.6%). Major bleeding events occurred in 17 (1.9%) patients. Bridging therapy was used in 315 (35%) patients. It was associated with minor (OR: 2.57 [1.3-5.07]) and major (OR: 4.2 [1.4-12.3]) bleeding events, without decreasing thrombotic events. Conclusion This study offers real-world data on perioperative DOAC management and outcomes in a large prospective sample size to date with a high percentage of major surgery. Short-term preprocedural DOAC interruption depending on the drug, hemorrhagic risk, and renal function, without bridging therapy and a reduced DOAC-free time, seems the safest practice.

State of the Art of Anthocyanins: Antioxidant Activity, Sources, Bioavailability, and Therapeutic Effect in Human Health.

The antioxidant activity of anthocyanins in food is well known. Numerous antioxidant assays have been proposed to measure the capacity of anthocyanins to prevent the oxidation process that naturally occurs. Different solvents, temperatures, and pH levels are applied in each assay, and these factors should be taken into account in order to obtain useful and reproducible results. The concentration and the structure of these compounds are directly related to their antioxidant capacity and their environment. However, the effectiveness of the anthocyanin ingestion against diseases is also influenced by its bioavailability. Novel methodologies that simulate the digestion process have been developed in order to facilitate the current knowledge of anthocyanins bioavailability. Studies highlight the potential synergy effect between parent compounds and their derivatives (metabolites, conjugated products, and microbe-generated metabolites). The aim of this review is to provide an overview of advantages and disadvantages of the most common methods to determine the antioxidant activity of anthocyanins, chemical structure, and concentration of these compounds in different edible fruits, vegetables, and plants; their bioavailability after intake; as well as the main therapeutic effect described in the scientific literature.

Selective pressurized extraction as single-step extraction and clean-up for the determination of organophosphate ester flame retardant in Citrus aurantium leaves by gas chromatography-tandem mass spectrometry.

In this work, an analytical method has been developed and validated for the determination of organophosphate esters (OPEs) in urban ornamental tree leaves. OPEs are flame retardants and plasticizers which are classified as health and environmental hazards substances. Their presence in urban air has been previously described. The method proposed in this work would allow the use of urban tree leaves as simple, cheap, and widely distributed in urban areas alternative to the existing active and passive sampler for sample collection. The method was based on sample treatment by selective pressurized liquid extraction (SPLE) and determination by gas chromatography with triple quadrupole mass spectrometry detector. After the optimization of the extraction solvent, the key parameters applied to SPLE (clean sorbent and sorbent amount applied for the sample clean-up, temperature, extraction cycles, and time) were optimized using a Box-Behnken response surface design. The method achieves high recoveries (higher than 60% for most of the target compounds), accuracies between 70 and 109%, and method detection and quantification limits ranged 0.05-4.96 ng/g dw (dry weight) and 0.15-14.4 ng/g dw, respectively. The method allowed the proper biomonitoring of OPE in tree leaves. Concentrations measured in analyzed samples were from 47.5 to 5477 ng/g dw (TEP). The most frequently detected compounds were triethyl phosphate tri-n-butyl phosphate, triphenyl phosphate, and tris(1-chloro-2-propyl)phosphate, while tris(2-ethylhexyl)phosphate was not detected in the analyzed samples. The proposed analytical method constitutes a starting point for the use of ornamental urban trees as passive sampler for the evaluation of OPE as air pollutants. Graphical Abstract.

Spinal anesthesia in a patient with Charcot-Marie-Tooth disease undergoing orthopedic surgery: case report / Anestesia raquídea en un paciente con enfermedad de Charcot-Marie-Tooth sometido a cirugía ortopédica: reporte de caso

Abstract Introduction: It is uncommon to come across patients with neuromuscular diseases in the daily practice of anesthesia, given the low prevalence of those conditions. Charcot-Marie-Tooth (CMT) disease is the most frequently, caused by an inherited abnormal myelin structure pattern. In view of the low prevalence of this condition (1:25,000), there is little information, derived mostly from case reports, about the use of neuroaxial anesthesia in these patients. Case presentation: Description of a patient with underlying CMT disease compromising lower limb mobility, who comes to the emergency service due to lower limb pain. After being diagnosed with an acetabular fracture, the patient underwent orthopedic surgery under spinal anesthesia, selected based on patient comorbidities, and the immediate postoperative follow-up. Results: The anesthetic and surgical procedures proceeded uneventfully and no neuropathic worsening was observed during the next 24 hours. Conclusion: Uneventful neuroaxial anesthesia is reported in a patient with neuromuscular disease. The case contributes to show the benefits and safety of this form of anesthesia when compared with other options.

Resumen Introducción: En la práctica anestésica diaria es raro enfrentarse a pacientes con patologías neuromusculares, dada la poca pre-valencia de dichas patologías. La más frecuente de ellas es la enfermedad de Charcot-Marie-Tooth, en la cual se hereda un patrón alterado en la estructura de la mielina. Debido a la baja prevalencia de esta patología (1:25000), el uso de anestesia neuroaxial en dichos pacientes no cuenta con mucha información, y mucha de ella proviene de reportes de casos. Presentación del caso: Se describe el caso de un paciente con enfermedad de Charcot-Marie-Tooth, de base, con compromiso de la movilidad en miembros inferiores, y quien asiste a urgencias por dolor en miembro inferior. Tras ser diagnosticado con fractura de acetábulo, fue sometido a cirugía ortopédica bajo anestesia raquídea, indicada a la luz de sus comorbilidades, y el posterior seguimiento inmediato. Resultados: Se realiza el procedimiento anestésico y quirúrgico sin complicaciones, y no se presenta empeoramiento de la neuropatía en las 24 horas posteriores. Conclusiones: Se reporta un caso de anestesia neuroaxial en paciente con enfermedad neuromuscular sin incidencias, que ayuda así a ir mostrando los beneficios de la mencionada anestesia y su seguridad frente a otras opciones.

Exposure assessment to parabens, bisphenol A and perfluoroalkyl compounds in children, women and men by hair analysis.

Population is continuously exposed to endocrine disrupting compounds present in everyday products such as parabens, bisphenol A (BPA), and perfluoroalkyl compounds (PFCs). The aims of this study were, first, to evaluate human exposure to three parabens (methylparaben (MeP), ethylparaben (EtP) and propylparaben (PrP)), BPA and six PFCs (perfluorobutanoic acid, perfluoropentanoic acid, perfluorohexanoic acid, perfluoroheptanoic acid (PFHpA), perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS)) through the analysis of hair samples from children, women and men and, then, to evaluate possible relationships between pollutant concentration in hair and age, gender, smoking and dyeing habits or hair colour. Hair samples were collected from 42 volunteers from Seville (Spain) (10 children, 16 women and 16 men). Six of the monitored pollutants (MeP, EtP, PrP, BPA, PFHpA and PFOS) were detected in at least 76% of the samples analysed. The highest concentrations and frequency of detection (100% of the samples) corresponded to MeP and PrP (up to 14,187 and 9009 ng/g, respectively). BPA was found in 83% of the samples at concentrations in the range from 24 to 1427 ng/g whereas PFCs were detected at concentrations in the range from 0.6 to 15.5 ng/g, being PFHpA and PFOS the ones most frequently detected (86% and 76%, respectively). Concentrations of BPA and parabens in adults were statistically higher than those in children. The results of this study reveal the suitability of hair for biomonitoring endocrine disrupting compounds of high concern (PFCs, parabens and BPA) to which population is internally or/and externally but continuously exposed.

Using the Technology Acceptance Model to Develop StartSmart: mHealth for Screening, Brief Intervention, and Referral for Risk and Protective Factors in Pregnancy.

INTRODUCTION: Technology decision support with tailored patient education has the potential to improve maternal and child health outcomes. The purpose of this study was to develop StartSmart, a mobile health (mHealth) intervention to support evidence-based prenatal screening, brief intervention, and referral to treatment for risk and protective factors in pregnancy. METHODS: StartSmart was developed using Davis' Technology Acceptance Model with end users engaged in the technology development from initial concept to clinical testing. The prototype was developed based upon the current guidelines, focus group findings, and consultation with patient and provider experts. The prototype was then alpha tested by clinicians and patients. Clinicians were asked to give feedback on the screening questions, treatment, brief motivational interviewing, referral algorithms, and the individualized education materials. Clinicians were asked about the feasibility of using the materials to provide brief intervention or referral to treatment. Patients were interviewed using the think aloud technique, a cognitive engineering method used to inform the design of mHealth interventions. Interview questions were guided by the Screening, Brief Intervention, Referral to Treatment theory and attention to usefulness and usability. RESULTS: Expert clinicians provided guidance on the screening instruments, resources, and practice guidelines. Clinicians suggested identifying specific prenatal visits for the screening (first prenatal visit, 28-week visit, and 36-week visit). Patients reported that the tablet-based screening was useful to promote adherence to guidelines and provided suggestions for improvement including more information on the diabetic diet and more resources for diabetes. During alpha testing, participants commented on navigability and usability. Patients reported favorable responses about question wording and ease of use. DISCUSSION: Clinicians reported the use of mHealth to screen and counsel pregnant patients on risk and protective factors facilitated their ability to provide comprehensive care.

A Mn-sensing riboswitch activates expression of a Mn2+/Ca2+ ATPase transporter in Streptococcus.

Maintaining manganese (Mn) homeostasis is important for the virulence of numerous bacteria. In the human respiratory pathogen Streptococcus pneumoniae, the Mn-specific importer PsaBCA, exporter MntE, and transcriptional regulator PsaR establish Mn homeostasis. In other bacteria, Mn homeostasis is controlled by yybP-ykoY family riboswitches. Here, we characterize a yybP-ykoY family riboswitch upstream of the mgtA gene encoding a PII-type ATPase in S. pneumoniae, suggested previously to function in Ca2+ efflux. We show that the mgtA riboswitch aptamer domain adopts a canonical yybP-ykoY structure containing a three-way junction that is compacted in the presence of Ca2+ or Mn2+ at a physiological Mg2+ concentration. Although Ca2+ binds to the RNA aptamer with higher affinity than Mn2+, in vitro activation of transcription read-through of mgtA by Mn2+ is much greater than by Ca2+. Consistent with this result, mgtA mRNA and protein levels increase ≈5-fold during cellular Mn stress, but only in genetic backgrounds of S. pneumoniae and Bacillus subtilis that exhibit Mn2+ sensitivity, revealing that this riboswitch functions as a failsafe 'on' signal to prevent Mn2+ toxicity in the presence of high cellular Mn2+. In addition, our results suggest that the S. pneumoniae yybP-ykoY riboswitch functions to regulate Ca2+ efflux under these conditions.

Unrecognised and unmet physical health problems in a national cohort of very low birthweight young adults and controls.

INTRODUCTION Young adults are often reluctant to seek medical attention. Compared with full-term controls, very low birthweight (<1500 g; VLBW) young adults may have more health problems. AIM To assess the frequency of unrecognised or unmet physical health needs during a comprehensive health and welfare assessment of a national cohort of VLBW adults born in 1986 compared with full-term controls. METHODS The VLBW cohort (n = 229; 71% of those alive) and controls (n = 100) aged 27-29 years were assessed in one University Hospital over 2 days. Physical health assessments included growth, respiratory function, blood pressure, echocardiogram, renal function, blood tests and an interview. Cranial MRI scans were performed on 150 VLBW adults and 50 controls. Significant unrecognised or unmet health needs were defined as including a body mass index (BMI) >30 plus raised fasting insulin >80 pmol/L; any two of moderate respiratory obstruction, or reduced diffusing capacity, or being a regular smoker; cardiovascular: hypertension or abnormal echocardiogram. RESULTS Among the VLBW cohort and controls; 61% versus 73% (P < 0.05) rated their overall health as very good or excellent. A general practitioner (GP) referral letter was sent for 44% VLBW adults and 38% controls, concerning metabolic problems in 20% and 17% respectively; respiratory problems in 12% and 4% (P < 0.05) respectively; cardiovascular problems in 14% and 12% respectively; abnormal renal function in 7% in both groups; and anaemia in 3% and 5% respectively. DISCUSSION Unrecognised or unmet health needs were frequent in both VLBW young adults and controls. Respiratory problems and hypertension were more frequent in the former. Continuity of care is important for VLBW adults who require a regular GP. GPs should routinely ask about gestation and birthweight and VLBW graduates should volunteer this information.

Enlaces y desenlaces de las psicosis: enseñanzas de Pizarnik / Bonds and outcomes of psychosis: lessons from Pizarnik

Este trabajo presenta algunos avances de una investigación sobre las psicosis y el lazo social. En esta ocasión presentaremos los hallazgos parciales del estudio del caso de la poeta Alejandra Pizarnik. El mismo estará construido a partir de fuentes publicadas en el que se han privilegiado datos convergentes y recurrentes, que presentaremos en los siguientes ejes: los enlaces con Bajarlía, su maestro, con Ostrov, su analista; el vínculo entre su escritura y la experiencia del sentimiento de la vida; y el desenlace. La orientación metodológica se sustenta en lo que Lacan formuló al proponer que el artista y el psicoanalista trabajan con el material de la condición humana, pero en esta tarea el artista precede al psicoanalista, para avanzar en la indagación sobre las formas en que un psicótico logra sostenerse en el lazo social, y en qué condiciones puede caer. Finalmente, cabe mencionar que nuestro estudio no se pretende exhaustivo sino que se propone presentar un esbozo de formalización de la experiencia subjetiva del lazo social en las psicosis desde una perspectiva no deficitaria, aún en construcción.

This paper presents some advances of a research on psychosis and the social bond. We will present the partial findings of the study of the case of the poet Alejandra Pizarnik. It will be constructed from published sources in which convergent and recurrent data have been privileged, which we will present in the following axes: the bonds with Bajarlía, her teacher, with Ostrov, his analyst; the link between his writing and the experience of the feeling of life; and the final outcome. The methodological orientation is based on what Lacan formulated when proposing that the artist and the psychoanalyst both work with the material of the human condition, but in this task the artist precedes the psychoanalyst, to advance in the investigation on the forms in which a psychotic manages to hold on to the social bond, and under what conditions he may fall. Finally, it is worth mentioning that our study is not intended to be exhaustive but rather to present an outline of formalization of the subjective experience of the social bond in psychoses from a non-deficit perspective, still under construction.

Recovery of Anthocyanins Using Membrane Technologies: A Review.

Anthocyanins are naturally occurring polyphenolic compounds and give many flowers, fruits and vegetable their orange, red, purple and blue colors. Besides their color attributes, anthocyanins have received much attention in recent years due to the growing evidence of their antioxidant capacity and health benefits on humans. However, these compounds usually occur in low concentrations in mixtures of complex matrices, and therefore large-scale harvesting is needed to obtain sufficient amounts for their practical usage. Effective fractionation or separation technologies are therefore essential for the screening and production of these bioactive compounds. In this context, membrane technologies have become popular due to their operational simplicity, the capacity to achieve good simultaneous separation/pre-concentration and matrix reduction with lower temperature and lower operating cost in comparison to other sample preparation methods. Membrane fractionation is based on the molecular or particle sizes (pressure-driven processes), on their charge (electrically driven processes) or are dependent on both size and charge. Other non-pressure-driven membrane processes (osmotic pressure and vapor pressure-driven) have been developed in recent years and employed as alternatives for the separation or fractionation of bioactive compounds at ambient conditions without product deterioration. These technologies are applied either individually or in combination as an integrated membrane system to meet the different requirements for the separation of bioactive compounds. The first section of this review examines the basic principles of membrane processes, including the different types of membranes, their structure, morphology and geometry. The most frequently used techniques are also discussed. Last, the specific application of these technologies for the separation, purification and concentration of phenolic compounds, with special emphasis on anthocyanins, are also provided.