Accuracy of a Smartwatch to Assess Heart Rate Monitoring and Atrial Fibrillation in Stroke Patients.

(1) Background: Consumer smartwatches may be a helpful tool to screen for atrial fibrillation (AF). However, validation studies on older stroke patients remain scarce. The aim of this pilot study from RCT NCT05565781 was to validate the resting heart rate (HR) measurement and the irregular rhythm notification (IRN) feature in stroke patients in sinus rhythm (SR) and AF. (2) Methods: Resting clinical HR measurements (every 5 min) were assessed using continuous bedside ECG monitoring (CEM) and the Fitbit Charge 5 (FC5). IRNs were gathered after at least 4 h of CEM. Lin's concordance correlation coefficient (CCC), Bland-Altman analysis, and mean absolute percentage error (MAPE) were used for agreement and accuracy assessment. (3) Results: In all, 526 individual pairs of measurements were obtained from 70 stroke patients-age 79.4 years (SD ± 10.2), 63% females, BMI 26.3 (IQ 22.2-30.5), and NIHSS score 8 (IQR 1.5-20). The agreement between the FC5 and CEM was good (CCC 0.791) when evaluating paired HR measurements in SR. Meanwhile, the FC5 provided weak agreement (CCC 0.211) and low accuracy (MAPE 16.48%) when compared to CEM recordings in AF. Regarding the accuracy of the IRN feature, analysis found a low sensitivity (34%) and high specificity (100%) for detecting AF. (4) Conclusion: The FC5 was accurate at assessing the HR during SR, but the accuracy during AF was poor. In contrast, the IRN feature was acceptable for guiding decisions regarding AF screening in stroke patients.

Discussing Challenges in Diagnosis of Tuberculous Meningitis and Neurosarcoidosis.

Isolated chronic granulomatous meningitis remains a diagnostic challenge for the physician. Symptoms are often nonspecific and ancillary tests have low-sensitivity rates, which may delay targeted treatment and lead to increased morbidity and mortality. Here, we discuss the challenges in diagnosing and treating patients with chronic meningitis by reporting two cases of previously healthy patients who presented with granulomatous meningitis on brain biopsy.

Blood donation attitudes and knowledge in Spanish undergraduates with roles in health-education.

BACKGROUND: Recent investigations highlight how important it is to identify the key factors involved in the design of strategies to promote blood donation among undergraduates as a public health concern. The study aims to investigate attitudes and knowledge towards blood donation in university students with health education roles and examine the way sociodemographic and educational characteristics play a part in it. MATERIALS AND METHODS: A cross-sectional and multi-center design was used. A structured questionnaire was answered by 1128 Spanish university students (Schools of Health Sciences and Education Sciences). RESULTS: The knowledge test indicated a low score (M = 4.2 out of 10), being Me = 3.00 in the case of Education Sciences and Me = 5.00 in Health Sciences students. The greatest degree of importance is found in the "external incentives" dimension (M = 3.7 out of 5). Health science students and participants with relatives who needed a donation showed fewer "fears" (p ≤ 0.001) and "pretexts" (p ≤ 0.01). CONCLUSIONS: The low knowledge score stresses the need to develop valuable health education-related strategies in the curriculum of studies related with health education; showing room for improvement particularly in Education Science students. Health education interventions aimed at increasing donors in the university environment should be designed while considering differences among undergraduates. Based on their better attitudes, health science students might play a relevant role in promoting blood donation.

First report of Leek yellow stripe virus, Onion yellow dwarf virus, and the putative allium polerovirus A in elephant garlic (Allium ampeloprasum) in Brazil.

Five elephant garlic plants (Allium ampeloprasum L.) showing leaf symptoms of chlorotic streaks and mosaic (Figure 1A and B) were collected, in September 2021, in an experimental area in municipality of Rio do Sul (27°11'07"S, 49°39'39"W), State of Santa Catarina, Brazil. Total RNA was extracted using TRIzol® reagent (Invitrogen, USA), according to the manufacturer's instructions to investigate viral infection. The RNA from all five plants were pooled into a single sample for cDNA library construction with the TruSeq Stranded Total RNA with Ribo-Zero Plant (Illumina) kit, which was then sequenced on the Illumina HiSeq2500 platform (Proteimax Biotechnology LTDA). After high throughput sequencing (HTS), 49 million raw reads (each 151nt) were generated. They were trimmed with the BBduk tool and de novo assembled with the Tadpole assembler tool (Geneious Software version 2022). A total of 28,345 contigs were generated and searched against the NCBI virus genome database using BLASTn and BLASTx, with positive results for two potyviruses, leek yellow stripe virus (LYSV), onion yellow dwarf virus (OYDV), and the putative polerovirus allium polerovirus A (APVA). The trimmed reads were mapped with the BBmap tool (Bushell 2014), using reference sequences for LYSV (NC_004011), OYDV (NC_005029), and APVA isolate Won (MH898527). A total of 806,060 reads were mapped, resulting in the nearly complete genome of LYSV (isolate RDS22-2, 10,268 bp, ON565071), which shared the highest (89.41%) nucleotide (nt) identity with LYSV isolate MG (KP258216). The nearly complete genome of OYDV (isolate RDS22-1, 10,519 bp, ON565070) was assembled using 311,467 reads, being 90.21% nt identical to OYDV isolate G-118 (KF632714). The APVA genome (isolate RDS22-3, 4,367 bp, ON565072, Figure 1C) was assembled from 116,303 reads and it shared the highest (90.73%) nt identity with APVA isolate Won. Subsequently, each sample was RT-PCR screened separately for potyviruses and poleroviruses, using the generic primer pairs NIb2F/NIb3R (Zheng et al., 2010) and Pol-G-F/Pol-G-R (Knierim et al., 2010), respectively. Amplified DNA fragments with approximately 350 bp and 1000 bp were obtained for potyviruses and poleroviruses, respectively, and were sent for Sanger sequencing (ACTGene, Alvorada, Brazil). The Sanger derived partial sequences shared 98 to 100% nt identities with corresponding HTS-derived sequences. The most common virus was LYSV, which was found in three of the five tested samples, whereas OYDV and APVA were only found in one sample each. The plants were also screened with specific primers for each virus, and none of the samples revealed mixed infections. Elephant garlic is primarily utilized for industrial garlic production in several countries, and it is now being researched in Brazil for the same purpose. It can be observed from this study that elephant garlic is susceptible to two of the most common viruses in garlic (LYSV and OYDV), which must be considered in the future while developing resistant varieties or in using thermotherapy and shoot tip/meristem culture to recover virus-free cultivars. LYSV and OYDV have already been described in Brazil infecting Allium sativum (Kitajima 2020). The only complete APVA sequence available is from China (Isolate Won), but no further characterization of the virus has been performed and published. The occurrence of this virus in Brazil highlights the importance of further research to obtain a more robust virus characterization.

First report of maize rayado fino virus in corn fields in Santa Catarina, Brazil.

Maize (Zea mays L.) is the main cereal food of humans and animals in Brazil. In 2020 and 2021, a severe infestation of corn leafhoppers (Dalbulus maidis; Hemiptera: Cicadellidae) was observed in Santa Catarina State (South of Brazil). Subsequently, symptoms of chlorotic stripes limited in leaf veins started to appear in maize plants. Given the similarity of symptoms and the presence of high populations of corn leafhoppers in corn production areas, 30 plants in reproductive stage showing systemic symptoms were collected in summer and autumn from commercial fields of five municipalities in Santa Catarina: Campos Novos (27°23'18.0"S, 51°12'52.7"W), Lages (27°47'17.8"S, 50°18'16.9"W), Mafra (26°06'42"S, 49°48'25"W), Fraiburgo (27°01'36"S, 50°55'19"W), and Abelardo Luz (26°34'02"S, 52°20'02"W). The young leaves of these samples were used for molecular analyses targeting the maize rayado fino virus (MRFV; Tymoviridae: Marafivirus). Total nucleic acids were extracted using TRIzol® (Invitrogen, USA), following the manufacturer's instructions. These were used as a template for cDNA synthesis with the enzyme MMLV-RT (Promega, USA), following the manufacturer's instructions. The polymerase chain reaction (PCR) was performed using Gotaq® DNA polymerase (Promega, USA) and MRFV-09/MRFV-10 primers (Hammond et al. 1997). All PCR products were subjected to electrophoresis in 1% agarose gel and were visualized under ultraviolet light. Twenty-eight of the 30 tested plants were MRFV-positive, showing a fragment with an expected size of ~633 bp. To confirm our results, all MRFV-positive samples were sent for sequencing (GenBank accession numbers OM763708 - OM763710 and ON730784 - ON730806) and submitted to BLASTn search (https://blast.ncbi.nlm.nih.gov/Blast.cgi), resulting in identities ranging from 96.21% to 99.21% with the isolate "Brazil 26" of MRFV, which was detected in 2005 in São Paulo, Brazil (GenBank accession nº: AF186178) (Hammond and Bedendo 2005). A second set of primers was used to validate the first PCR, confirming MRFV infection (data not shown).Moreover, whitish streaks and leaf reddening were observed on the leaves of some plants; therefore, the identification for phytoplasmas (Candidatus Phytoplasma asteris) and spiroplasmas (Spiroplasma kunkelii) from the corn stunt complex was performed. For this, previously extracted nucleic acids from each sample were used as templates for a multiplex PCR using the primers CSSR6/CSSF2 and R16F2n/R16R2 (Gundersen and Lee 1996; Barros et al. 2001). Two plants were infected with only spiroplasma, 17 samples were infected with Spiroplasma and MRFV, and three samples were infected by these three pathogens. An increasing incidence of corn stunt has been observed in commercial fields in Santa Catarina in recent years. Mollicutes are commonly found and mostly studied as causal agents of corn stunt disease. On the contrary, despite being present in Brazil since the 1970s, the virus is less studied because its contribution to the corn stunt complex is still unknown (Hammond and Bedendo 2001). In this report, indications that the virus is expanding to different regions in southern Brazil were observed, which raises an opportunity for further evaluation and its consideration in monitoring programs. Moreover, to the best of our knowledge, this is the first report of MRFV in Santa Catarina, Brazil.

Positive and Negative Feelings among Spanish Young-Old and Old-Old during the Lockdown of the COVID-19 First Wave.

OBJECTIVES: The COVID-19 pandemic required a population lockdown during the first wave in March 2020. Evidence has shown a circular relationship between perceived threat and the risk of developing negative mood, which might impact the affect balance of older adults. We aimed to investigate the positive and negative feelings expressed by young-old (60-70 years) and old-old (over 71 years) Spanish adults during the lockdown of the COVID-19 first wave, and the social and psychological variables associated. METHODS: Cross-sectional study conducted in 528 participants using a questionnaire composed of sociodemographic data and validated scales for resilience (Brief Resilient Coping Scale) and emotions (Scale of Positive and Negative Experience). RESULTS: We found a positive balance between positive and negative feelings with no differences between both groups. Regression analysis showed that social network and resilience, but not age, are significant predictors of both greater positive feelings and lower negative feelings. CONCLUSIONS: Our results evidence the relevance of promoting targeted support psychological and social measures that effectively help older adults to cope with such a difficult scenario as the current pandemic. CLINICAL IMPLICATIONS: Health-care providers must develop targeted care strategies aimed at providing emotional support for older adults from a holistic perspective.

A systematic review of the educational experiences and needs of children with cancer returning to school.

AIMS: To critically review and synthesize empirical studies on childhood cancer survivors' experiences and needs on returning to school after treatment. DESIGN: A mixed-method systematic review. DATA SOURCES: A search of CINAHL, PsycINFO, EMBASE, MEDLINE, ERIC and Web of Science was conducted for studies published in English, Spanish and Portuguese languages between January 2010 and May 2020. REVIEW METHODS: Twenty-one studies were eligible for inclusion (13 qualitative studies, 6 quantitative and 2 mixed-method studies). The quality of the studies was assessed using the Critical Appraisal Skills Programme and the Mixed Methods Appraisal Tool. Findings were synthesized using data-based convergent synthesis design. RESULTS: Findings were synthesized under four themes: academic continuity and school re-entry; physical and psychological well-being; school life and participation and stakeholders' responses to childhood cancer. Findings indicated that prolonged/recurring absences, physical and mental changes, personal/health factors impacted children's social participation, peer relationships and school re-integration. Factors which contributed to a more positive experience included maintaining contact with peers and teachers throughout treatment, peer relationships, understanding and support from school community. Sharing information about cancer was an ongoing challenging issue for children, that needed to be handled sensitively. CONCLUSION: It is evident that re-entry to school was very challenging for most children due to treatment side effects, prolonged absences, disrupted peer relationships, lack of preparation and lack of communication between schools, families and healthcare professionals. IMPACT: Despite the growing number of childhood cancer survivors worldwide, there is a deficit of studies about children's re-entry experiences and educational needs. This review illustrates the considerable challenges that children face on school re-entry and the critical importance of better care, support and collaboration from healthcare professionals, parents and school personnel. Nurses could help by raising awareness and leading on preparation for school re-entry.

Care tasks and impact of caring in primary family caregivers: A cross-sectional study from a nursing perspective.

BACKGROUND: Family caregivers of persons with dementia often experience a negative impact on their health. More studies based on nursing theories are needed to improve the provision of care. AIMS: To describe the care provided by family caregivers of persons with dementia and the impact on their health, as well as to analyse how personal variables of caregivers are related to care tasks and their health impact. METHODS: Multi-centric cross-sectional prospective study conducted on a sample of 423 primary family caregivers of persons with dementia from Spain. Data were collected through ICUB97-R questionnaire (January-April 2019), based on the fourteen needs of Virginia Henderson's Nursing Model. Data was analysed through one-way analysis of variance and Student's t-test. RESULTS: The caregiver profile was a middle-aged married woman without higher education living with the cared person, predominantly her mother. The most frequently provided care corresponded to "nutrition" and "movement" needs. Lack of free time, modifications on leisure activities, reduced sleep or rest and disruption of family life emerged as the greatest repercussions on the caregiver's health. The age of the caregiver and time caring showed differences on impact of care and care tasks, respectively. CONCLUSION: The identification of the types of care provided, the health impact of caring and the variables affecting the family caregiver's vulnerability is essential to develop effective individualised nursing care plans, including health education interventions to improve the quality of life of both caregivers and persons cared for.

Matrix Stiffness: the Conductor of Organ Fibrosis.

PURPOSE OF REVIEW: Organ fibrosis is a lethal component of scleroderma. The hallmark of scleroderma fibrosis is extensive extracellular matrix (ECM) deposition by activated myofibroblasts, specialized hyper-contractile cells that promote ECM remodeling and matrix stiffening. The purpose of this review is to discuss novel mechanistic insight into myofibroblast activation in scleroderma. RECENT FINDINGS: Matrix stiffness, traditionally viewed as an end point of organ fibrosis, is now recognized as a critical regulator of tissue fibrogenesis that hijacks the normal physiologic wound-healing program to promote organ fibrosis. Here, we discuss how matrix stiffness orchestrates fibrosis by controlling three fundamental pro-fibrotic mechanisms: (a) mechanoactivation of myofibroblasts, (b) integrin-mediated latent transforming growth factor beta 1 (TGF-ß1) activation, and (c) activation of non-canonical TGF-ß1 signaling pathways. We also summarize novel therapeutic targets for anti-fibrotic therapy based on the mechanobiology of scleroderma. Future research on mechanobiology of scleroderma may lead to important clinical applications such as improved diagnosis and treatment of patients with scleroderma and other fibrotic-related diseases.

Allopurinol and progression of CKD and cardiovascular events: long-term follow-up of a randomized clinical trial.

BACKGROUND: Asymptomatic hyperuricemia increases renal and cardiovascular (CV) risk. We previously conducted a 2-year, single-blind, randomized, controlled trial of allopurinol treatment that showed improved estimated glomerular filtration rate and reduced CV risk. STUDY DESIGN: Post hoc analysis of a long-term follow-up after completion of the 2-year trial. SETTING & PARTICIPANTS: 113 participants (57 in the allopurinol group and 56 in the control group) initially followed up for 2 years and 107 participants followed up to 5 additional years. INTERVENTION: Continuation of allopurinol treatment, 100mg/d, or standard treatment. OUTCOME: Renal event (defined as starting dialysis therapy and/or doubling serum creatinine and/or ≥50% decrease in estimated estimated glomerular filtration rate) and CV events (defined as myocardial infarction, coronary revascularization or angina pectoris, congestive heart failure, cerebrovascular disease, and peripheral vascular disease). RESULTS: During initial follow-up, there were 2 renal and 7 CV events in the allopurinol group compared with 6 renal and 15 CV events in the control group. In the long-term follow-up period, 12 of 56 participants taking allopurinol stopped treatment and 10 of 51 control participants received allopurinol. During long-term follow-up, an additional 7 and 9 participants in the allopurinol group experienced a renal or CV event, respectively, and an additional 18 and 8 participants in the control group experienced a renal or CV event, respectively. Thus, during the initial and long-term follow-up (median, 84 months), 9 patients in the allopurinol group had a renal event compared with 24 patients in the control group (HR, 0.32; 95% CI, 0.15-0.69; P=0.004; adjusted for age, sex, baseline kidney function, uric acid level, and renin-angiotensin-aldosterone system blockers). Overall, 16 patients treated with allopurinol experienced CV events compared with 23 in the control group (HR, 0.43; 95% CI, 0.21-0.88; P=0.02; adjusted for age, sex, and baseline kidney function). LIMITATIONS: Small sample size, single center, not double blind, post hoc follow-up and analysis. CONCLUSIONS: Long-term treatment with allopurinol may slow the rate of progression of kidney disease and reduce CV risk.

Management of resistant hypertension: aldosterone antagonists or intensification of diuretic therapy?

OBJECTIVE: No consensus has been established as to which is the best fourth-line agent in patients with resistant hypertension (RHT). The aim of the present study was to assess the effect of intensifying diuretic treatment with loop diuretic (furosemide) or aldosterone antagonist (spironolactone) on blood pressure (BP) control in RHT. METHODS: The study population comprised 30 patients with RHT who were divided into two treatment arms. Fifteen patients received furosemide 40 mg/day and 15 patients received spironolactone 25 mg/day. Ambulatory BP monitoring was performed baseline, 3 and 6 months. RESULTS: Baseline BP was 162 ± 8/90 ± 6 mmHg, 70% men, mean age 63.3 ± 9.1 years 56.1% diabetic and estimated glomerular filtration rate (eGFR) 55.8 ± 16.5 mL/min per 1.73 m(2) . There were no significant differences between groups at baseline in age, gender, percentage diabetics, eGFR, BP, number of antihypertensive drugs, or aldosterone levels. At 6 months, systolic BP decreased by 24 ± 9.2 mmHg (from 163.6 ± 8.6 to 139.6 ± 8.1 mmHg) in the spironolactone group, compared with 13.8 ± 2.8 mmHg (from 162 ± 7.9 to 148 ± 6.4 mmHg) in the furosemide group (P < 0.01). Diastolic BP fell 11 ± 8.1 mmHg in the spironolactone group compared with 5.2 ± 2.2 mmHg in the furosemide group (P < 0.01). Significant reduction in urinary albumin creatinine ratio (from 173 ± 268 to 14 ± 24 mg/g, P < 0.01) was observed in the spironolactone group at 6 months. Multiple regression analysis showed that only treatment with spironolactone was associated with control of BP < 140/90 mmHg at 6 months. No severe adverse events were recorded. CONCLUSION: Spironolactone is more effective than furosemide for control of BP in RHT patients, with a positive added effect on albuminuria. Spironolactone is safe in patients with mild kidney impairment, although serum potassium should be closely monitored, especially in diabetics.

The sirtuin inhibitor cambinol impairs MAPK signaling, inhibits inflammatory and innate immune responses and protects from septic shock.

Sirtuins (SIRT1-7) are NAD(+)-dependent histone deacetylases (HDACs) that play an important role in the control of metabolism and proliferation and the development of age-associated diseases like oncologic, cardiovascular and neurodegenerative diseases. Cambinol was originally described as a compound inhibiting the activity of SIRT1 and SIRT2, with efficient anti-tumor activity in vivo. Here, we studied the effects of cambinol on microbial sensing by mouse and human immune cells and on host innate immune responses in vivo. Cambinol inhibited the expression of cytokines (TNF, IL-1ß, IL-6, IL-12p40, and IFN-γ), NO and CD40 by macrophages, dendritic cells, splenocytes and whole blood stimulated with a broad range of microbial and inflammasome stimuli. Sirtinol, an inhibitor of SIRT1 and SIRT2 structurally related to cambinol, also decreased macrophage response to TLR stimulation. On the contrary, selective inhibitors of SIRT1 (EX-527 and CHIC-35) and SIRT2 (AGK2 and AK-7) used alone or in combination had no inhibitory effect, suggesting that cambinol and sirtinol act by targeting more than just SIRT1 and SIRT2. Cambinol and sirtinol at anti-inflammatory concentrations also did not inhibit SIRT6 activity in in vitro assay. At the molecular level, cambinol impaired stimulus-induced phosphorylation of MAPKs and upstream MEKs. Going well along with its powerful anti-inflammatory activity, cambinol reduced TNF blood levels and bacteremia and improved survival in preclinical models of endotoxic shock and septic shock. Altogether, our data suggest that pharmacological inhibitors of sirtuins structurally related to cambinol may be of clinical interest to treat inflammatory diseases.

Dermatology Self-Medication in Nursing Students and Professionals: A Multicentre Study.

Current evidence shows that the prevalence of self-medication in healthcare professionals and their students is troublingly high despite them knowing the risks involved. There is limited research on self-medication in dermatology, and there are even fewer studies on this practice among nurses and nursing students, despite the potential mucocutaneous health problems that may affect them. The aims of our study were to examine the prevalence of self-medication mainly in the field of dermatology among nurses and nursing students as well as to explore if age or years of professional/academic practice influenced such behaviour. This multicentre cross-sectional study was conducted in 2021. In total, 120 nurses from the University Hospital of Pontevedra and 303 nursing students from the Universities of Vigo and Santiago de Compostela (N-W Spain) participated in this study (n = 423). An ad hoc questionnaire was used to evaluate self-medication decision-making. Self-medication for dermatological diseases was reported by 58.39% (n = 247) of participants. Among our respondents, 44.44% of nurses and 42.68% of students would recommend treatment for skin diseases to a third party. We found a higher prevalence of medication without prescription in nurses than in students (p < 0.001). More experience (p = 0.01) and older age (p < 0.001) were associated with more self-medication in the case of nurses and students, respectively. The prevalence of self-medication and treatment recommendation to a third party are cause for concern. Identifying these situations and associated factors may help to implement evidence-based strategies and education.

Predictive variables for hard cardiac events and coronary revascularization in patients with normal left ventricular myocardial perfusion and systolic function.

BACKGROUND: The objective of this study was to investigate the impact of clinical, electrocardiographic and stress testing variables in predicting hard cardiac events (HE) and coronary revascularization (CR) in patients with normal stress-rest gated SPECT. MATERIALS AND METHODS: Included in the study were 2,004 patients (63.5 ± 12.5 years, 41.6% men) with normal myocardial perfusion and left ventricular ejection fraction (LVEF) >50% on gated SPECT who were followed for HE (cardiovascular death or acute myocardial infarction) and CR. RESULTS: During a follow-up of 4.3 ± 2.4 years, 33 patients (1.6 %; 0.4%/year) had HE and 50 patients (2.5%; 0.6%/year) underwent CR. In a univariate analysis, age ≥65 years, insulin-dependent diabetes mellitus (IDDM), left bundle branch block (LBBB), and pharmacological stress were associated with HE. Independent predictors of HE were age ≥65 years (p < 0.001; HR 6.9), IDDM (p = 0.014; HR 3.4), and LBBB (p = 0.002; HR 4.6). In the univariate analysis, male gender, LVEF, known coronary artery disease (CAD), LBBB, and a positive stress test were associated with CR. Independent predictors of CR were known CAD (p = 0.016; HR 2.1), and a positive stress test (p = 0.006; HR 2.3). CONCLUSION: Age ≥65 years, IDDM, and LBBB are HE-independent predictors in patients with normal myocardial perfusion and normal LVEF on gated SPECT. The presence of known CAD or a positive stress test significantly increases the probability of CR during follow-up.

How to Ensure Patency of the Extracorporeal Circuit in Hemodialysis: Global Perspectives.

An adequate knowledge of anticoagulants used to prevent clotting in the extracorporeal circuit is crucial to provide optimal hemodialysis. Drugs can potentially prevent extracorporeal circuit clotting, but administration, half-life, and potential side effects differ. However, there is a lack of concise recommendations to guide anticoagulation and to avoid side effects. Because of the development of newer anticoagulant agents, direct thrombin inhibitors, and heparinoids, some of the side effects related to heparin may be overcome, but a deeper knowledge of these newer drugs is necessary. Moreover, types of heparin used, routes of administration, and health care economics vary around the world. We performed an extensive review of the literature, and the present article focuses on available anticoagulant drugs, exploring doses, side effects, particular use in hemodialysis, mechanism of action, pharmacokinetic properties, and use in special situations. Classical anticoagulants are still the standard of anticoagulation, but many questions remain unanswered; for example, is there real superiority of one treatment over another in terms of efficacy, safety, and health care economics? Anticoagulant protocols for hemodialysis need to be standardized and further studies performed to answer all of these questions.

Identifying engagement and associated factors in nursing students: An exploratory study.

BACKGROUND: Burnout and engagement in health students surpass work life. Although levels of burnout in Nursing students are high, academic engagement is an understudied topic in Nursing, which has shown benefits. The aims were to know the level of engagement of Nursing students and to identify factors that prompt higher levels of engagement. METHODS: An exploratory study was conducted during 2019 in three Universities in Spain. The UWES-S-17 questionnaire was used. RESULTS: The sample consisted of 808 Nursing students. An average level of engagement was found. Engagement differed significantly by gender and age, with females and older students showing greater attitudes. Participants in the second year showed lower scores in the willingness to dedicate effort and persistence than those in the first and third year (p < 0.05). CONCLUSIONS: The identification of the level of engagement and factors involved are an opportunity to probe into this approach by reinforcing positive attitudes in Nursing students. These findings show the need to seek strategies through specific educational interventions and policies. Engagement should be upheld throughout the degree and once they enter the job market to ensure the well-being during academic and future work life, a high-quality nursing care and patient safety.

Novel Gold Nanorods@Thiolated Pectin on the Killing of HeLa Cells by Photothermal Ablation.

Gold nanorods (AuNRs) have attracted attention in the field of biomedicine, particularly for their potential as photothermal agents capable of killing tumor cells by photothermic ablation. In this study, the synthesis of novel AuNRs stabilized with thiolated pectin (AuNR@SH-PEC) is reported. To achieve this, thiolated pectin (SH-PEC) was obtained by chemically binding cysteamine motifs to the pectin backbone. The success of the reaction was ascertained using FTIR-ATR. Subsequently, the SH-PEC was used to coat and stabilize the surface of AuNRs (AuNR@SH-PEC). In this context, different concentrations of SH-PEC (0.25, 0.50, 1.0, 2.0, 4.0, and 8.0 mg/mL) were added to 0.50 mL of AuNRs suspended in CTAB, aiming to determine the experimental conditions under which AuNR@SH-PEC maintains stability. The results show that SH-PEC effectively replaced the CTAB adsorbed on the surface of AuNRs, enhancing the stability of AuNRs without affecting their optical properties. Additionally, scanning electron and atomic force microscopy confirmed that SH-PEC is adsorbed into the surface of the AuNRs. Importantly, the dimension size (60 × 15 nm) and the aspect ratio (4:1) remained consistent with those of AuNRs stabilized with CTAB. Then, the photothermal properties of gold nanorods were evaluated by irradiating the aqueous suspension of AuNR@SH-PEC with a CW laser (808 nm, 1 W). These results showed that photothermal conversion efficiency is similar to the photothermal conversion observed for AuNR-CTAB. Lastly, the cell viability assays confirmed that the SH-PEC coating enhanced the biocompatibility of AuNR@SH-PEC. Most important, the viability cell assays subjected to laser irradiation in the presence of AuNR@SH-PEC showed a decrease in the cell viability relative to the non-irradiated cells. These results suggest that AuNRs stabilized with thiolated pectin can potentially be exploited in the implementation of photothermal therapy.

Online (versus face-to-face) augmented reality experience on nursing students' leg ulcer competency: Two quasi-experimental studies.

AIM: The aim of this study was two-fold. Firstly, to describe the influence of an augmented reality (AR)-based online educational experience on the academic performance and learning determinants of nursing students related to the study of leg ulcer care. We also set out to compare these online results with those obtained in the same experience developed a year before but in a face-to-face design. BACKGROUND: Undergraduate education in nursing aims to train students towards an acceptable level of competence for professional practice. Sometimes, some essential clinical areas of knowledge are particularly challenging for both students and nurse educators. One of these is the care of chronic wounds, particularly in leg ulcers where nurses play a key role. Currently face-to-face teaching methods are evolving to more active contexts and alternative means such as online learning and AR are becoming widely used, garnering encouraging results. DESIGN: A quasi-experimental design was used. Two experiments were carried out to meet the aims of the study, the first one was a pre-test post-test design in one group and the second one a post-test two experimental groups design. METHODS: Participants were undergraduate nursing students from the School of Nursing of the University of Santiago de Compostela (Spain). The two experimental groups received the same training but in different environments: online during 2019/2020 (n = 111) and onsite during 2018/2019 (n = 72). The instruments selected were a knowledge and skills test and two validated questionnaires. RESULTS: Regarding academic performance, the study demonstrated significant differences towards learning after the AR-based online experience (Z = -9.074; p ≤ 0.001). The participants also showed good results in relation to the learning determinants studied. Compared with students receiving AR-based face-to-face teaching, the students with the online learning approach scored better in the dimensions Autonomous Learning (U=3104.5; p = 0.020) and 3D Comprehension (U=3167.0; p = 0.035). However, the participants in the onsite experience scored higher in the Attention dimension (U=3163.0; p = 0.035). CONCLUSIONS: AR positively influences academic performance and diverse educational variables when this experience is carried out online. Since both the online and face-to-face experience show statistically significant benefits in different dimensions of the learning determinants, the need to improve the AR learning experience through blended-learning environments should be promoted.

Signature-driven repurposing of Midostaurin for combination with MEK1/2 and KRASG12C inhibitors in lung cancer.

Drug combinations are key to circumvent resistance mechanisms compromising response to single anti-cancer targeted therapies. The implementation of combinatorial approaches involving MEK1/2 or KRASG12C inhibitors in the context of KRAS-mutated lung cancers focuses fundamentally on targeting KRAS proximal activators or effectors. However, the antitumor effect is highly determined by compensatory mechanisms arising in defined cell types or tumor subgroups. A potential strategy to find drug combinations targeting a larger fraction of KRAS-mutated lung cancers may capitalize on the common, distal gene expression output elicited by oncogenic KRAS. By integrating a signature-driven drug repurposing approach with a pairwise pharmacological screen, here we show synergistic drug combinations consisting of multi-tyrosine kinase PKC inhibitors together with MEK1/2 or KRASG12C inhibitors. Such combinations elicit a cytotoxic response in both in vitro and in vivo models, which in part involves inhibition of the PKC inhibitor target AURKB. Proteome profiling links dysregulation of MYC expression to the effect of both PKC inhibitor-based drug combinations. Furthermore, MYC overexpression appears as a resistance mechanism to MEK1/2 and KRASG12C inhibitors. Our study provides a rational framework for selecting drugs entering combinatorial strategies and unveils MEK1/2- and KRASG12C-based therapies for lung cancer.

Intraindividual interleukin-6 variations on the cardiovascular prognosis of patients with chronic renal disease.

In chronic kidney disease (CKD) patients on dialysis, plasma interleukin (IL)-6 levels predict mortality better than other markers. Impact of intraindividual changes of inflammatory markers on cardiovascular (CV) events in CKD patients is unknown. The aim of this study is to demonstrate the relation between CV outcomes and variations of C-reactive protein (CRP), IL-6, IL-1ß, and tumor necrosis factor (TNF)-α in CKD. Ninety patients (mean age: 68.5 ± 12.8 years) at different stages (1-4) of CKD were evaluated. Serum CRP, IL-6, IL-1ß, and TNF-α were measured basally and after taking statins or angiotensin II receptor blockers. Three patterns were defined for each marker (baseline, mean of two measurements, and variation of the marker: increase or decrease after 6 months). During follow-up (mean time: 72.7 ± 19.8 months), 14 patients died, 11 were included on dialysis program, and 29 suffered a CV event. Patients with persistently elevated IL-6 values had higher risk to develop CV events [OR = 1.21 (1.11-1.32), p = 0.001]. Mean of two measurements of IL-6 was a better predictor for events than a single measurement of IL-6, CRP, TNF-α, and IL-1ß. A mean of two determinations of plasma IL-6 greater than 6 pg/mL and previous peripheral vascular disease was related to an increased risk for CV events [2.34 (1.05-5.22), p = 0.037 and 2.95 (1.27-6.93), p = 0.011, respectively] in an adjusted Cox regression model. IL-6 is a better inflammatory marker than CRP, TNF-α, and IL1ß at predicting CV events in CKD nondialysis patients. Mean of two measurements is better than simple determinations at predicting CV outcome.