Nirmatrelvir-Ritonavir and Symptoms in Adults With Postacute Sequelae of SARS-CoV-2 Infection: The STOP-PASC Randomized Clinical Trial.

Importance: There is an urgent need to identify treatments for postacute sequelae of SARS-CoV-2 infection (PASC). Objective: To assess the efficacy of a 15-day course of nirmatrelvir-ritonavir in reducing the severity of select PASC symptoms. Design, Setting, and Participants: This was a 15-week blinded, placebo-controlled, randomized clinical trial conducted from November 2022 to September 2023 at Stanford University (California). The participants were adults with moderate to severe PASC symptoms of 3 months or longer duration. Interventions: Participants were randomized 2:1 to treatment with oral nirmatrelvir-ritonavir (NMV/r, 300 mg and 100 mg) or with placebo-ritonavir (PBO/r) twice daily for 15 days. Main Outcomes and Measures: Primary outcome was a pooled severity of 6 PASC symptoms (fatigue, brain fog, shortness of breath, body aches, gastrointestinal symptoms, and cardiovascular symptoms) based on a Likert scale score at 10 weeks. Secondary outcomes included symptom severity at different time points, symptom burden and relief, patient global measures, Patient-Reported Outcomes Measurement Information System (PROMIS) measures, orthostatic vital signs, and sit-to-stand test change from baseline. Results: Of the 155 participants (median [IQR] age, 43 [34-54] years; 92 [59%] females), 102 were randomized to the NMV/r group and 53 to the PBO/r group. Nearly all participants (n = 153) had received the primary series for COVID-19 vaccination. Mean (SD) time between index SARS-CoV-2 infection and randomization was 17.5 (9.1) months. There was no statistically significant difference in the model-derived severity outcome pooled across the 6 core symptoms at 10 weeks between the NMV/r and PBO/r groups. No statistically significant between-group differences were found at 10 weeks in the Patient Global Impression of Severity or Patient Global Impression of Change scores, summative symptom scores, and change from baseline to 10 weeks in PROMIS fatigue, dyspnea, cognitive function, and physical function measures. Adverse event rates were similar in NMV/r and PBO/r groups and mostly of low grade. Conclusions and Relevance: The results of this randomized clinical trial showed that a 15-day course of NMV/r in a population of patients with PASC was generally safe but did not demonstrate a significant benefit for improving select PASC symptoms in a mostly vaccinated cohort with protracted symptom duration. Further studies are needed to determine the role of antivirals in the treatment of PASC. Trial Registration: ClinicalTrials.gov Identifier: NCT05576662.

On-demand drug delivery bioelectronics through a water-processable low dimensional highly conductive MXene layer.

On-demand drug delivery holds great promise to optimize pharmaceutical efficacy while minimizing the side effects. However, existing on-demand drug delivery systems often require complicated manufacturing processes that preclude their wide implementation of a broad range of drugs. In this work, we demonstrate the introduction of MXene-coated microneedles (MNs) into bioelectronics for digitally controllable gate-valve drug delivery. MXenes, featuring high electronic conductivity, excellent biocompatibility, and solution processibility, enable low-cost scalability for printable bioelectronics. In an electrolytic state (e.g., body fluid), the coated MXene is oxidized and desorbed due to redox reactions caused by electrical bias, allowing the underlying drug to be controllably released. The MXene-incorporated drug delivery system not only demonstrates excellent biocompatibility and operational stability, but also features low-cost construction and sustainable usage. Besides, these MXene-coated MNs allow both on-demand transformation and local-region customization, further increasing the structural versatility and capability of multidrug delivery systems.

Pyrethroid susceptibility reversal in Aedes aegypti: A longitudinal study in Tapachula, Mexico.

Pyrethroid resistance in Aedes aegypti has become widespread after almost two decades of frequent applications to reduce the transmission of mosquito-borne diseases. Because few insecticide classes are available for public health use, insecticide resistance management (IRM) is proposed as a strategy to retain their use. A key hypothesis of IRM assumes that negative fitness is associated with resistance, and when insecticides are removed from use, susceptibility is restored. In Tapachula, Mexico, pyrethroids (PYRs) were used exclusively by dengue control programs for 15 years, thereby contributing to selection for high PYR resistance in mosquitoes and failure in dengue control. In 2013, PYRs were replaced by organophosphates-insecticides from a class with a different mode of action. To test the hypothesis that PYR resistance is reversed in the absence of PYRs, we monitored Ae. aegypti's PYR resistance from 2016 to 2021 in Tapachula. We observed significant declining rates in the lethal concentration 50 (LC50), for permethrin and deltamethrin. For each month following the discontinuation of PYR use by vector control programs, we observed increases in the odds of mosquitoes dying by 1.5% and 8.4% for permethrin and deltamethrin, respectively. Also, knockdown-resistance mutations (kdr) in the voltage-gated sodium channel explained the variation in the permethrin LC50s, whereas variation in the deltamethrin LC50s was only explained by time. This trend was rapidly offset by application of a mixture of neonicotinoid and PYRs by vector control programs. Our results suggest that IRM strategies can be used to reverse PYR resistance in Ae. aegypti; however, long-term commitment by operational and community programs will be required for success.

Assessing Pulmonary Epithelial Damage in Hantavirus Cardiopulmonary Syndrome: Challenging the Predominant Role of Vascular Endothelium through sRAGE as a Potential Biomarker.

Hantavirus cardiopulmonary syndrome (HCPS) is a severe respiratory illness primarily associated with microvascular endothelial changes, particularly in the lungs. However, the role of the pulmonary epithelium in HCPS pathogenesis remains unclear. This study explores the potential of soluble Receptors for Advanced Glycation End-products (sRAGE) as a biomarker for assessing pulmonary epithelial damage in severe HCPS, challenging the prevailing view that endothelial dysfunction is the sole driver of this syndrome. We conducted a cross-sectional study on critically ill HCPS patients, categorizing them into mild HCPS, severe HCPS, and negative control groups. Plasma sRAGE levels were measured, revealing significant differences between the severe HCPS group and controls. Our findings suggest that sRAGE holds promise as an indicator of pulmonary epithelial injury in HCPS and may aid in tracking disease progression and guiding therapeutic strategies. This study brings clarity on the importance of investigating the pulmonary epithelium's role in HCPS pathogenesis, offering potential avenues for enhanced diagnostic precision and support in this critical public health concern.

Tolerability, safety and pharmacodynamics of oral, small-molecule glucagon-like peptide-1 receptor agonist danuglipron for type 2 diabetes: A 12-week, randomized, placebo-controlled, Phase 2 study comparing different dose-escalation schemes.

AIM: To evaluate the tolerability, safety and pharmacodynamics of different dose-escalation schemes of the oral small-molecule glucagon-like peptide-1 receptor (GLP-1R) agonist danuglipron. MATERIALS AND METHODS: This Phase 2a, double-blind, placebo-controlled, parallel-group study randomly assigned adults with type 2 diabetes (T2D) treated with metformin to placebo or danuglipron (low [5-mg] or high [10-mg] starting dose, with 1- or 2-week dose-escalation steps, to target doses of 80, 120 or 200 mg twice daily [BID]) and adults with obesity without diabetes to placebo or danuglipron 200 mg BID. RESULTS: Participants with T2D (n = 123, mean glycated haemoglobin [HbA1c] 8.19%) or obesity without diabetes (n = 28, mean body mass index 37.3 kg/m2 ) were randomly assigned and treated. Discontinuation from study medication occurred in 27.3% to 72.7% of participants across danuglipron groups versus 16.7% to 18.8% for placebo, most often due to adverse events. Nausea (20.0%-47.6% of participants across danuglipron groups vs. 12.5% for placebo) and vomiting (18.2%-40.9% danuglipron vs. 12.5% placebo, respectively) were most commonly reported in participants with T2D. Gastrointestinal adverse events were generally related to danuglipron target dose and were not substantially affected by starting dose. In participants with T2D, least squares mean changes from baseline in HbA1c (-1.04% to -1.57% across danuglipron groups vs. -0.32% for placebo), fasting plasma glucose (-23.34 mg/dL to -53.94 mg/dL danuglipron vs. -13.09 mg/dL placebo) and body weight (-1.93 to -5.38 kg danuglipron vs. -0.42 kg placebo) at Week 12 were generally statistically significant for danuglipron compared with placebo (P < 0.05). CONCLUSIONS: Danuglipron resulted in statistically significant reductions in HbA1c, FPG and body weight over 12 weeks, in the setting of higher discontinuation rates and incidence of gastrointestinal adverse events with higher target doses. CLINICALTRIALS: gov identifier: NCT04617275.

Hantavirus in humans: a review of clinical aspects and management.

Hantavirus infections are part of the broad group of viral haemorrhagic fevers. They are also recognised as a distinct model of an emergent zoonotic infection with a global distribution. Many factors influence their epidemiology and transmission, such as climate, environment, social development, ecology of rodent hosts, and human behaviour in endemic regions. Transmission to humans occurs by exposure to infected rodents in endemic areas; however, Andes hantavirus is unique in that it can be transmitted from person to person. As hantaviruses target endothelial cells, they can affect diverse organ systems; increased vascular permeability is central to pathogenesis. The main clinical syndromes associated with hantaviruses are haemorrhagic fever with renal syndrome (HFRS), which is endemic in Europe and Asia, and hantavirus cardiopulmonary syndrome (HCPS), which is endemic in the Americas. HCPS and HFRS are separate clinical entities, but they share several features and have many overlapping symptoms, signs, and pathogenic alterations. For HCPS in particular, clinical outcomes are highly associated with early clinical suspicion, access to rapid diagnostic testing or algorithms for presumptive diagnosis, and prompt transfer to a facility with critical care units. No specific effective antiviral treatment is available.

Soil adsorption and transport of lead in the presence of perovskite solar cell-derived organic cations.

Perovskite photovoltaics offer a highly efficient and low-cost solar energy harvesting technology. However, the presence of lead (Pb) cations in photovoltaic halide perovskite (HaPs) materials is concerning, and quantifying the environmental hazard of accidental Pb2+ leaching into the soil is crucial for assessing the sustainability of this technology. Pb2+ from inorganic salts was previously found to remain in the upper soil layers due to adsorption. However, Pb-HaPs contain additional organic and inorganic cations, and competitive cation adsorption may affect Pb2+ retention in soils. Therefore, we measured, analyzed by simulations and report the depths to which Pb2+ from HaPs penetrates into 3 types of agricultural soil. Most of the HaP-leached Pb2+ is found to be retained already in the first cm of the soil columns, and subsequent rain events do not induce Pb2+ penetration below the first few cm of soil surface. Surprisingly, organic co-cations from the dissolved HaP are found to enhance the Pb2+ adsorption capacity in clay-rich soil, compared to non-HaP-based Pb2+ sources. Our results imply that installation over soil types with improved Pb2+ adsorption, and removal of only the contaminated topsoil, are sufficient means to prevent ground water contamination by HaP-leached Pb2+.

Characterizing Density and Spatial Distribution of Trap States in Ta3N5 Thin Films for Rational Defect Passivation.

Tantalum nitride (Ta3N5) has gained significant attention as a potential photoanode material, yet it has been challenged by material quality issues. Defect-induced trap states are detrimental to the performance of any semiconductor material. Beyond influencing the performance of Ta3N5 films, defects can also accelerate the degradation in water during desired electrochemical applications. Defect passivation has provided an enormous boost to the development of many semiconductor materials but is currently in its infancy for Ta3N5. This is in part due to a lack of experimental understanding regarding the spatial and energetic distribution of trap states throughout Ta3N5 thin films. Here, we employ drive-level capacitance profiling (DLCP) to experimentally resolve the spatial and energetic distribution of trap states throughout Ta3N5 thin films. The density of deeper energetic traps is found to reach ∼2.5 to 6 × 1022 cm-3 at the interfaces of neat Ta3N5 thin films, over an order of magnitude greater than the bulk. In addition to the spatial profile of deep trap states, we report neat Ta3N5 thin films to be highly n-type in nature, owning a free carrier density of ∼9.74 × 1017 cm-3. This information, coupled with the present understanding of native oxide layers on Ta3N5, has facilitated the rational design of a targeted passivation strategy that simultaneously provides a means for catalyst immobilization. Loading catalyst via silatrane moieties suppresses the density of defects at the surface of Ta3N5 thin films by two orders of magnitude, while also reducing the free carrier density of films by over one order of magnitude, effectively dedoping the films to ∼2.40 × 1016 cm-3. The surface passivation of Ta3N5 films translates to suppressed defect-induced trapping and recombination of photoexcited carriers, as determined through absorption, photoluminescence, and transient photovoltage. This illustrates how developing a deeper understanding of the distribution and influence of defects in Ta3N5 thin films has the potential to guide future works and ultimately accelerate the integration and development of high-performance Ta3N5 thin film devices.

Running to Prevent Depression; Maximal Aerobic Speed for Adolescents in the South of Belgium. Comparison With Their Parents' Generation and the Impact on Their Physical and Mental Health.

OBJECTIVE: To assess aerobic fitness of adolescents, using maximum aerobic speed (MAS). To test the relationship between MAS and other variables. To compare our 2019/21 data to similar data published in 1996. METHODS: A running application was used to measure MAS with the half-Cooper test. To test age, BMI, gender and school attended as possible predictors of MAS, multiple logistic regressions were performed. A series of t-tests and ANOVAs were performed to test differences between the variable means. t-tests were used to compare MAS, height and weight of our population to a similar population tested during the late 1990s. RESULTS: Our sample of 3368 adolescent students shows that age, BMI, gender and the school attended are predictors of MAS. MAS increases more significantly between 13 and 15 years of age, particularly in males. MAS is significantly greater in males compared to females at all ages between 12 and 18 years. When compared to a reference population in the 1990s, our data shows: significantly lower MAS at ages 14, 15, 16 and 17 for males and at 17 for females. Males' weight is significantly higher at each age between 12 and 17, but height only significantly higher at 12, 14 and 15 years of age. Females' weight is significantly higher in each age category between 14 and 17 years of age, but height only at 12 and 14 years old. CONCLUSIONS: The aerobic fitness in adolescent students was correlated to age, BMI, gender and school attended. After 12 years old, MAS evolved differently in males and females. Our data suggests a decline in MAS since the 1990s at as early as 14 years of age in males and 17 for females, and an increased weight, which is suggestive of a decline in health. The impact of MAS decline on mental health will be discussed.

The Place of Care under Constraint for Mood Disorders in the Context of the Collapse of the Supply of Psychiatric Care during the COVID-19 Crisis.

BACKGROUND: In March 2020, the Belgian population was exposed to a confinement situation that it had never experienced before associated with the collapse in access to psychiatric care. Initially, only emergencies and constrained care continued to operate. In these specific circumstances, where both the overall population and the psychiatric population, was exposed to unique stress factors, what was the role of forced psychiatric internments in the treatment of mood disorders? SUBJECTS AND METHODS: We have measured the number of detentions for observation with and without suicide attempt over the two years prior to the pandemic in order to obtain theoretical reference values. We have compared these values with the measures over the 12 months following the start of the confinement period, which constitute the Crisis values. The continuation of measures, with an equal number of observation measures, constituted the Post-Crisis values. For these same cases, we compared in suicide attempt cases, whether the criteria for Severe Major Depressive Disorder were met or not. Lastly we compared the number of observation measures that were lifted, or not, within ten days of patient care. RESULTS: There was no significant increase in Detentions for Observation following a suicide attempt during the Crisis period. However a significant increase was observed during the Post-Crisis period. As regards cases of attempted suicide during the Crisis period, the number of patients suffering from Major Depressive Disorders reduced significantly in terms of statistics. This confirms our impression of a change in population. The Post-Crisis values dropped to the Theoric values. The number of Observation measures lifted increased quite significantly during the Crisis period, while there was a return to values in terms of statistics similar to the Theoric values during the Post-Crisis period. CONCLUSIONS: Although the population, both the healthy population and those suffering from a psychiatric condition, was subject to stress that it had never before experienced coinciding with a collapse of healthcare provision, there was no increase in patients meeting the criteria to benefit from constrained care during the Crisis period. On the other hand, there was a significant change in statistical terms in the population of patients who attempted suicide. We have seen a collapse in the number of patients suffering from depressive disorders and an equivalent increase in the number of patients with personality disorders or adjustment disorders. The number of Observation measures lifted during the Crisis period also grew quite significantly. Constrained care was available to help manage reactive suicide attempts. All other things being equal, they indirectly showed a reduction in Major Depressive Disorders requiring constrained care in the population.

Increased respiratory dead space could associate with coagulation activation and poor outcomes in COVID-19 ARDS.

PURPOSE: To determine whether VDPhys/VT is associated with coagulation activation and outcomes. MATERIALS AND METHODS: We enrolled patients with COVID-19 pneumonia who were supported by invasive mechanical ventilation and were monitored using volumetric capnography. Measurements were performed during the first 24 h of mechanical ventilation. The primary endpoint was the likelihood of being discharge alive on day 28. RESULTS: Sixty patients were enrolled, of which 25 (42%) had high VDPhys/VT (>57%). Patients with high vs. low VDPhys/VT had higher APACHE II (10[8-13] vs. 8[6-9] points, p = 0.002), lower static compliance of the respiratory system (35[24-46] mL/cmH2O vs. 42[37-45] mL/cmH2O, p = 0.005), and higher D-dimer levels (1246[1050-1594] ng FEU/mL vs. 792[538-1159] ng FEU/mL, p = 0.001), without differences in P/F ratio (157[112-226] vs. 168[136-226], p = 0.719). Additionally, D-dimer levels correlated with VDPhys/VT (r = 0.530, p < 0.001), but not with the P/F ratio (r = -0.103, p = 0.433). Patients with high VDPhys/VT were less likely to be discharged alive on day 28 (32% vs. 71%, aHR = 3.393[1.161-9.915], p = 0.026). CONCLUSIONS: In critically ill COVID-19 patients, increased VDPhys/VT was associated with high D-dimer levels and a lower likelihood of being discharged alive. Dichotomic VDPhys/VT could help identify a high-risk subgroup of patients neglected by the P/F ratio.

Reaction Mechanisms of the Electrosynthesis of Magnetite Nanoparticles Studied by Electrochemical Impedance Spectroscopy.

This work presents a mechanistic study of the electrochemical synthesis of magnetite nanoparticles (NPs) based on the analysis of the electrochemical impedance spectroscopy (EIS) technique. After a discussion of the mechanisms reported in the literature, three models are devised and a prediction of their EIS spectra is presented. The approach consisted of the simulation of EIS spectra as a tool for assessing model validity, as EIS allows to characterize the relaxation of adsorbed intermediates. The comparison between the simulated impedance spectra and the experimental results shows that the mechanisms proposed to date do not explain all of the experimental results. Thus, a new model is proposed, in which up to three adsorbed intermediate species are involved. This model accounts for the number of loops found in experimental impedance data. The closest approximation of the features found in the experimental spectra by this proposed model suggests a better representation of the reaction mechanism within the evaluated potential range.

Cambios afectivos en niñas/os y adolescentes: antes y durante el confinamiento preventivo por covid-19

Objetivo: Analizar cambios afectivos en niños/as y adolescentes entre 8 y 16 años, antes y durante el confinamiento por Pandemia de COVID-19. Material y Método: Estudio observacional-transversal con medición repetida evocada. Bajo muestreo no-probabilístico, se encuestó en formato online a 87 niños/as y adolescentes escolarizados voluntarios, mediante el cuestionario de afectividad positiva/negativa para niños, adicionando preguntas sociodemográficas. Se realizó análisis descriptivo/asociativo para conocer el comportamiento de la afectividad infanto-juvenil pre y posconfinamiento. Resultados: Se observó disminución significativa de la afectividad positiva durante el confinamiento (Z =-3,073; p= ,002), además de aumento significativo en la probabilidad de que el estado afectivo previo, positivo (OR= 32,1: IC 95% 8,1 - 127,2) o negativo (OR= 10,8: IC 95% 3,9 - 29,4), incremente el deterioro de la afectividad presente. Por último, no se registraron cambios significativos en la afectividad negativa antes y durante el confinamiento. Conclusiones: Durante el periodo de confinamiento se aprecia deterioro en la percepción de bienestar emocional asociado a una disminución del afecto positivo, siendo la afectividad previa un factor de riesgo de deterioro del bienestar percibido por los niños/as y adolescentes. Se requiere potenciar la capacidad de afrontamiento de los/as infantes para que el afecto positivo se constituya en un factor protector ante nuevas catástrofes.

Objective: To analyze affective changes in children and adolescents between 8 and 16 years of age, before and during COVID-19 lockdown. Materials and Methods: Observational, cross-sectional study with repeated evoked measurement. Under non-probabilistic sampling, 87 voluntary school children and adolescents were surveyed online using the positive/negative affect questionnaire for children, with the addition of sociodemographic questions. Descriptive/associative analysis was performed to determine the behavior of child and adolescent affectivity before and after lockdown. Results: A significant decrease in positive affect during lockdown was observed (Z =-3.073; p=.002), as well as a significant increase in the probability that the previous affective state, positive (OR: 32.1: 95% CI 8.1 - 127.2) or negative (OR: 10.8: 95% CI 3.9 - 29.4), would increase the deterioration of present affectivity. Finally, there were no significant changes in negative affectivity before and during lockdown. Conclusions: During lockdown, a deterioration in the perception of emotional well-being associated with a decrease in positive affect was observed, with previous affectivity being a risk factor for the deterioration of well-being perceived by children and adolescents. It is necessary to strengthen the coping capacity of children so that positive affect becomes a protective factor in the face of new catastrophes.

Objetivo: Analisar as mudanças afetivas em crianças e adolescentes entre os 8 e 16 anos de idade, antes e durante o confinamento. Materiais e Métodos: Estudo observacional transversal com medições evocadas repetidas. Sob amostragem não-probabilística, 87 crianças e adolescentes foram inquiridos online utilizando o questionário de afeto positivo/negativo para crianças, com o acréscimo de perguntas sociodemográficas. Foi realizada uma análise descritiva/associativa para determinar o comportamento da afetividade infantil e adolescente pré e pós- confinamento. Resultados: Houve uma diminuição significativa do afeto positivo durante o confinamento (Z=-3,073; p= ,002), bem como um aumento significativo da probabilidade de que o estado afetivo anterior, positivo (OR= 32,1: 95% CI 8,1 - 127,2) ou negativo (OR= 10,8: 95% CI 3,9 - 29,4), aumentasse a deterioração da afetividade atual. Finalmente, não houve mudanças significativas no afeto negativo antes e durante o confinamento. Conclusões: Durante o período de confinamento, observou-se uma deterioração da percepção do bem-estar emocional associada a uma diminuição do afeto positivo, sendo a afetividade anterior um fator de risco para a deterioração do bem-estar percebido pelas crianças e adolescentes. É necessário fortalecer a capacidade de reação das crianças para que o afeto positivo se torne um fator de proteção face a novas catástrofes.

Proteinuria in Hantavirus Cardiopulmonary Syndrome: A Frequent Finding Linked To Mortality.

OBJECTIVES: To determine the relative frequency and prognosis value of proteinuria in hantavirus cardiopulmonary syndrome (HCPS) due to Andes virus. METHODS: This observational analytical study prospectively obtained data from patients admitted to 12 health centers in nine Chilean cities between 2001 and 2018. Only patients with confirmed Andes virus HCPS and laboratory characterization that included qualitative proteinuria determination at admission were considered. RESULTS: The database involved 175 patients, 95 of them had a measurement of urine protein at the time of hospital admission. They were mainly male (71%) and the median age was 35 [22-47] years. Median duration of the febrile prodromal time was 5 [4-7] days. Hospital length of stay and hospital mortality rate were 10 [7-14] days and 21.1%, respectively. Seventy-three patients (77%) were identified with proteinuria at admission, which was associated with increased mortality rate (26% versus 5%, p=0.036) and the relative risk was 1.3 [1.1-1.6], p=0.002. CONCLUSIONS: Proteinuria is a frequent finding in patients with HCPS, which is associated with a higher mortality rate.

Outcomes of Sepsis and Septic Shock in Cancer Patients: Focus on Lactate.

The number of oncological patients (OP) admitted to intensive care units (ICU) for sepsis/septic shock has dramatically increased in recent years. The definition of septic shock has been modified, adding hyperlactatemia as a severity biomarker for mortality. However, it remains poorly reported in septic OP. We performed a retrospective analysis from a prospective database of sepsis/septic shock patients admitted to our ICU between September 2017 and September 2019 and followed until day 90. We identified 251 patients and 31.9% had active oncological comorbidity, mainly solid tumor (81.3%). Septic shock criteria were met for 112 (44.6%). Hyperlactatemia was observed in 136 (54.2%) patients and this was associated with a lower survival rate. Overall 90-day mortality was 15.1%. In OP vs. non-OP, hyperlactatemia was more frequent (65% vs. 49.1%, p = 0.013) and associated with lower survival (65.4% vs. 85.7%, p = 0.046). In OP, poor performance status was also associated with lower survival (HR 7.029 [1.998-24.731], p = 0.002) In an adjusted analysis, cancer was associated with lower 90-day survival (HR 2.690 [1.402-5.160], p = 0.003). In conclusion, septic OP remains a high mortality risk group in whom lactate levels and performance status could help with better risk stratification.

Targeted high volume hemofiltration could avoid extracorporeal membrane oxygenation in some patients with severe Hantavirus cardiopulmonary syndrome.

BACKGROUND: Hantavirus cardiopulmonary syndrome (HCPS) has a high lethality. Severe cases may be rescued by venoarterial extracorporeal membrane oxygenation (VA ECMO), alongside substantial complications. High volume hemofiltration (HVHF) is a depurative technique that provides homeostatic balance allowing hemodynamic stabilization in some critically ill patients. METHODS: We implemented HVHF before VA ECMO consideration in the last five severe HCPS patients requiring mechanical ventilation and vasoactive drugs admitted to our intensive care unit. Patients were considered HVHF-responders if VA ECMO was avoided and HVHF-nonresponders if VA ECMO support was needed despite HVHF. A targeted-HVHF strategy compounded by aggressive hyperoncotic albumin, sodium bicarbonate, and calcium supplementation plus ultrafiltration to avoid fluid overload was implemented on three patients. RESULTS: Patients had maximum serum lactate of 8.8 (8.7-12.8) mmol/L and a lowest cardiac index of 1.8 (1.8-1.9) L/min/m2 . The first two required VA ECMO. They were connected later to HVHF, displayed progressive tachycardia and declining stroke volume. The opposite was true for HVHF-responders who received targeted-HVHF. All patients survived, but one of the VA ECMO patients suffered a vascular complication. CONCLUSION: HVHF may contribute to support severe HCPS patients avoiding the need for VA ECMO in some. Early connection and targeted-HVHF may increase the chance of success.

Dye-Sensitized Nonstoichiometric Strontium Titanate Core-Shell Photocathodes for Photoelectrosynthesis Applications.

A core-shell approach that utilizes a high-surface-area conducting core and an outer semiconductor shell is exploited here to prepare p-type dye-sensitized solar energy cells that operate with a minimal applied bias. Photocathodes were prepared by coating thin films of nanocrystalline indium tin oxide with a 0.8 nm Al2O3 seeding layer, followed by the chemical growth of nonstoichiometric strontium titanate. Films were annealed and sensitized with either a porphyrin chromophore or a chromophore-catalyst molecular assembly consisting of the porphyrin covalently tethered to the ruthenium complex. The sensitized photoelectrodes produced cathodic photocurrents of up to -315 µA/cm2 under simulated sunlight (AM1.5G, 100 mW/cm2) in aqueous media, pH 5. The photocurrent was increased by the addition of regenerative hole donors to the system, consistent with slow interfacial recombination kinetics, an important property of p-type dye-sensitized electrodes.

Impact of early ICU admission for critically ill cancer patients: Post-hoc analysis of a prospective multicenter multinational dataset.

OBJECTIVES: Early intensive care unit (ICU) admission, in Critically Ill Cancer Patients (CICP), is believed to have contributed to the prognostic improvement of critically ill cancer patients. The primary objective of this study was to assess the association between early ICU admission and hospital mortality in CICP. DESIGN: Retrospective analysis of a prospective multicenter dataset. Early admission was defined as admission in the ICU < 24 h of hospital admission. We assessed the association between early ICU admission and hospital mortality in CICP via survival analysis and propensity score matching. RESULTS: Of the 1011patients in our cohort, 1005 had data available regarding ICU admission timing and were included. Overall, early ICU admission occurred in 455 patients (45.3%). Crude hospital mortality in patients with early and delayed ICU admission was 33.6% (n = 153) vs. 43.1% (n = 237), respectively (P = 0.02). After adjustment for confounders, early compared to late ICU admission was not associated with hospital mortality (HR 0.92; 95%CI 0.76-1.11). After propensity score matching, hospital mortality did not differ between patients with early (35.2%) and late (40.6%) ICU admission (P = 0.13). In the matched cohort, early ICU admission was not associated with mortality after adjustment on SOFA score (HR 0.89; 95%CI 0.71-1.12). Similar results were obtained after adjustment for center effect. CONCLUSION: In this cohort, early ICU admission was not associated with a better outcome after adjustment for confounder and center effect. The uncertainty with regard to the beneficial effect of early ICU on hospital mortality suggests the need for an interventional study.

Estudio cualitativo sobre el bienestar en adolescentes con y sin riesgo suicida / Qualitative study on well-being in adolescents with and without risk of suicide / Estudo Qualitativo sobre o bem-estar em adolescentes com e sem risco de suicídio

OBJETIVO: Conocer y comprender las nociones y estrategias de bienestar presentes en adolescentes con altos y bajos niveles de riesgo suicida. METODOLOGÍA: Este estudio exploratorio con enfoque cualitativo mediante el cual se analizaron las diferencias entre las nociones de bienestar y las estrategias recurrentes en 40 adolescentes con puntuaciones alta y bajas de riesgo suicida. RESULTADOS: Indican la existencia de nociones asociadas a la salud, a la visión integradora y a una perspectiva subjetiva. En cuanto a las estrategias usadas por los adolescentes para promover su propio bienestar las categorías que emergieron se centraron en la interacción social, el hedonismo, el control, la redefinición y proyección subjetiva positiva, y la orientación al cambio. CONCLUSIÓN: Se discuten los resultados sobre la orientación de estrategias de intervención en adolescentes con alto riesgo suicida basados en sus propias nociones

OBJECTIVE: To know and understand the notions and strategies of well-being present in adolescents with high and low levels of suicidal risk. METHODOLOGY: This exploratory study with qualitative approach, which explored the differences between notions of well-being and recurrent strategies in 40 adolescents with high and low suicide risk scores.Results. Indicate the existence of notions associated with health, the integrating vision and a subjective perspective. Regarding the strategies used by adolescents to promote their own well-being, the categories that emerged focused on social interaction, hedonism, control, redefinition and positive subjective projection, and orientation towards change. CONCLUSION: Results on the orientation of intervention strategies in adolescents with high suicide risk based on their own notions are discussed

OBJETIVO: Conhecer e compreender as noções e estratégias de bem-estar presentes em adolescentes com alto e baixo risco de suicídio. METODOLOGIA: Estudo exploratório com abordagem qualitativa, que explorou as diferenças entre noções de bem-estar e estratégias recorrentes em 40 adolescentes com escores de alto e baixo risco de suicídio. RESULTADOS: Indicar a existência de noções associadas à saúde, a visão integradora e uma perspectiva subjetiva. Em relação às estratégias utilizadas pelos adolescentes para promover seu próprio bem-estar, as categorias que emergiram enfocaram a interação social, o hedonismo, o controle, a redefinição e a projeção subjetiva positiva e a orientação para a mudança. CONCLUSÃO: Os resultados sobre a orientação das estratégias de intervenção em adolescentes com alto risco de suicídio com base em suas próprias noções são discutido

Chitosan-BaTiO3 nanostructured piezopolymer for tissue engineering.

Herein we report the synthesis of a piezopolymer composed of chitosan (CS)/hydroxylated BaTiO3 (OH-BTO) nanoparticles with enhanced biocompatibility, non-toxicity, and piezoelectric behavior that can be advantageously used in biomedical applications. Our CS/OH-BTO nanocomposites exhibit piezoelectric coefficient (d33 = 11.29 pC/N) between those of dry skin (0.05-0.19 pC/N) and bone (4-11 pC/N), demonstrating biocompatibility in contact with human fibroblasts (HF) cells after 24 h. SEM, XRD, FTIR and Raman measurements were performed to assess the mechanism of interaction between CS matrix and OH-BTO NPs and their correlation with the biological responses. Cytotoxicity assays with HF cells reveal that hydroxylation of BTO NPs does not affect the cell viability of CS/OH-BTO films with NPs concentration from 1 to 30 wt.%. In contrast, non-hydroxylated BTO NPs showed significant cell damage, which could be traced to uncontrollable NPs agglomeration. This behavior suggests that CS/OH-BTO nanocomposites can act as active material that promotes cell growth and can be used for biomedical purposes.