Impact of natriuresis on worsening renal function during episodes of acute heart failure.

INTRODUCTION AND OBJECTIVES: Worsening renal function (WRF) is a frequent complication in acute heart failure (AHF) with a controversial prognostic value. We aimed to study the usefulness of natriuresis to evaluate WRF. METHODS: We conducted an observational, prospective, multicenter study of patients with AHF who underwent a furosemide stress test. The patients were classified according to whether WRF was present or absent and according to the median natriuretic response. The main endpoint was the combination of mortality, rehospitalization due to HF, and heart transplant at 6 months of follow-up. RESULTS: One hundred and fifty-six patients were enrolled, and WRF occurred in 60 (38.5%). The patients were divided into 4 groups: a) 47 (30.1%) no WRF/low UNa (UNa ≤ 109 mEq/L); b) 49 (31.4%) no WRF/high UNa (UNa > 109 mEq/L); c) 31 (19.9%) WRF/low UNa and d) 29 (18.6%) WRF/high UNa. The parameters of the WRF/low UNa group showed higher clinical severity and worse diuretic and decongestive response. The development of WRF was associated with a higher risk of the combined event (HR, 1.88; 95%CI, 1.01-3.50; P = .046). When stratified by natriuretic response, WRF was associated with an increased risk of adverse events in patients with low natriuresis (HR, 2.28; 95%CI, 1.15-4.53; P = .019), but not in those with high natriuresis (HR, 1.18; 95%CI, 0.26-5.29; P = .826). CONCLUSIONS: Natriuresis could be a useful biomarker for interpreting and prognosticating WRF in AHF. WRF is associated with a higher risk of adverse events only in the context of low natriuresis.

Tissue explants as tools for studying the epigenetic modulation of the GH-IGF-I axis in farmed fish.

Somatic growth in vertebrates is mainly controlled by the growth hormone (GH)/insulin-like growth factor I (IGF-I) axis. The role of epigenetic mechanisms in regulating this axis in fish is far from being understood. This work aimed to optimize and evaluate the use of short-term culture of pituitary and liver explants from a farmed fish, the gilthead seabream Sparus aurata, for studying epigenetic mechanisms involved in GH/IGF-I axis regulation. Our results on viability, structure, proliferation, and functionality of explants support their use in short-term assays. Pituitary explants showed no variation in gh expression after exposure to the DNA methylation inhibitor decitabine (5-Aza-2'-deoxycytidine; DAC), despite responding to DAC by changing dnmt3bb and tet1 expression, and TET activity, producing an increase in overall DNA hydroxymethylation. Conversely, in liver explants, DAC had no effects on dnmt s and tet s expression or activity, but modified the expression of genes from the GH-IGF-I axis. In particular, the expression of igfbp2a was increased and that of igfbp4, ghri and ghrii was decreased by DAC as well as by genistein, which is suggestive of impaired growth. While incubation of liver explants with S-adenosylmethionine (SAM) produced no clear effects, it is proposed that nutrients must ensure the methylation milieu within the liver in the fish to sustain proper growth, which need further in vivo verification. Pituitary and liver explants from S. aurata can be further used as described herein for the screening of inhibitors or activators of epigenetic regulators, as well as for assessing epigenetic mechanisms behind GH-IGF-I variation in farmed fish.

Induced-aggregates in photocatalysis: An unexplored approach to reduce the noble metal co-catalyst content.

Photocatalysis has emerged as a promising and environmentally sustainable solution to produce high-purity hydrogen through ethanol photoreforming. It is commonly accepted that adding co-catalysts, especially noble metals, significantly enhances the catalytic activity of semiconductors. However, the high cost of noble metals such as Pt may limit the real application of this emerging technology. Here we evaluate the possibility of reducing the noble metal loading by creating the appropriate interface between pre-formed semiconductor nanoparticles. Commercial titania (P25) was selected as the semiconductor due to its commercial availability, facilitating the straightforward validation and corroboration of our results. Pt was selected as co-catalyst because one of the most efficient photocatalysts for the ethanol photo-reforming is still based on the use of P25 in combination with Pt. We report that the creation of induced aggregates dramatically improves the total hydrogen produced when very low loadings (≤0.05 wt%) of Pt are used. We have developed a pioneering reactor designed for conducting photoluminescence studies under authentic operational conditions of nanoparticle suspensions in the liquid phase. This approach allows us to obtain the average photoluminescence emission from the P25 agglomerates what it would be impossible to obtain by using standard solid samples holders. Thanks to this equipment, we can conclude that this remarkable improvement of the activity is mainly due to creation of an interface that favors the charge transfer between the particles of the aggregates. According to this, the titania nanoparticles of the agglomerates act as an antenna to collect the photons of the sun-light and produce the photo-excited electrons that will be transferred to the platinum nanoparticles located in the same agglomeration. In contrast, raw P25 with low loadings of Pt would have a high number of titania nanoparticles without platinum, and therefore, inactive. This result would be especially relevant in the case of immobilized photocatalytic systems for real future photocatalytic reactors because the immobilization of the semiconductors would generate similar interactions to the one created by our method. Consequently, the initial semiconductor immobilization followed by the subsequent photo-deposition of the co-catalyst emerges as a promising approach for a substantial reduction of the co-catalyst content.

Identification and Composition of Cyanobacteria in Ecuadorian Shrimp Farming Ponds-Possible Risk to Human Health.

Toxic cyanobacterial blooms in various water bodies have been given much attention nowadays as they release hazardous substances in the surrounding areas. These toxic planktonic cyanobacteria in shrimp ponds greatly affect the survival of shrimps. Ecuador is the second highest shrimp producing country in the Americas after Brazil; and the shrimp-based economy is under threat due to toxic cyanobacterial blooms in Ecuador shrimp ponds. This study investigated the abundance of different cyanobacteria in the shrimp ponds at the Chone and Jama rivers (in Manabi province) at Ecuadorian pacific coast, focusing on different environmental factors, such as temperature, pH, salinity, and light. Temperature and pH were identified as key factors in influencing the abundance of cyanobacteria, with a significant positive correlation between Raphidiopsis raciborskii and pH. The highest and lowest abundance of cyanobacteria found during the dry season in the shrimp ponds near the Chone and Jama rivers were > 3 × 106 and 1 × 106 Cell.m-3, respectively. The Shannon-Wiener Diversity Index fluctuated between 0.41-1.15 and 0.31-1.15 for shrimp ponds of Chone and Jama rivers, respectively. This variation was linked to changes in salinity and the presence of harmful algal blooms, highlighting the importance of continuous monitoring. Additionally, the study areas showed eutrophic conditions with low diversity, underlining the need for additional spatiotemporal studies and expanded research in both rivers, to better understand these complex phenomena. The findings underscore the importance of continuous monitoring and expanded research in cyanobacteria ecology, with implications for public health and aquatic resource management.

Sex and Gender-related Disparities in Clinical Characteristics and Outcomes in Heart Transplantation.

PURPOSE OF REVIEW: Limited research has been conducted on sex disparities in heart transplant (HT). The aim of this review is to analyse the available evidence on the influence of sex and gender-related determinants in the entire HT process, as well as to identify areas for further investigation. RECENT FINDINGS: Although women make up half of the population affected by heart failure and related mortality, they account for less than a third of HT recipients. Reasons for this inequality include differences in disease course, psychosocial factors, concerns about allosensitisation, and selection or referral bias in female patients. Women are more often listed for HT due to non-ischaemic cardiomyopathy and have a lower burden of cardiovascular risk factors. Although long-term prognosis appears to be similar for both sexes, there are significant disparities in post-HT morbidity and causes of mortality (noting a higher incidence of rejection in women and of malignancy and cardiac allograft vasculopathy in men). Additional research is required to gain a better understanding of the reasons behind gender disparities in eligibility and outcomes following HT. This would enable the fair allocation of resources and enhance patient care.

Insights into spheroids formation in cellulose nanofibrils and Matrigel hydrogels using AFM-based techniques.

The recent FDA decision to eliminate animal testing requirements emphasises the role of cell models, such as spheroids, as regulatory test alternatives for investigations of cellular behaviour, drug responses, and disease modelling. The influence of environment on spheroid formation are incompletely understood, leading to uncertainty in matrix selection for scaffold-based 3D culture. This study uses atomic force microscopy-based techniques to quantify cell adhesion to Matrigel and cellulose nanofibrils (CNF), and cell-cell adhesion forces, and their role in spheroid formation of hepatocellular carcinoma (HepG2) and induced pluripotent stem cells (iPS(IMR90)-4). Results showed different cell behaviour in CNF and Matrigel cultures. Both cell lines formed compact spheroids in CNF but loose cell aggregates in Matrigel. Interestingly, the type of cell adhesion protein, and not the bond strength, appeared to be a key factor in the formation of compact spheroids. The gene expression of E- and N-cadherins, proteins on cell membrane responsible for cell-cell interactions, was increased in CNF culture, leading to formation of compact spheroids while Matrigel culture induced integrin-laminin binding and downregulated E-cadherin expression, resulting in looser cell aggregates. These findings enhance our understanding of cell-biomaterial interactions in 3D cultures and offer insights for improved 3D cell models, culture biomaterials, and applications in drug research.

Exploring Fracture Patterns: Assessing Representation Methods for Bone Fracture Simulation.

Fracture pattern acquisition and representation in human bones play a crucial role in medical simulation, diagnostics, and treatment planning. This article presents a comprehensive review of methodologies employed in acquiring and representing bone fracture patterns. Several techniques, including segmentation algorithms, curvature analysis, and deep learning-based approaches, are reviewed to determine their effectiveness in accurately identifying fracture zones. Additionally, diverse methods for representing fracture patterns are evaluated. The challenges inherent in detecting accurate fracture zones from medical images, the complexities arising from multifragmentary fractures, and the need to automate fracture reduction processes are elucidated. A detailed analysis of the suitability of each representation method for specific medical applications, such as simulation systems, surgical interventions, and educational purposes, is provided. The study explores insights from a broad spectrum of research articles, encompassing diverse methodologies and perspectives. This review elucidates potential directions for future research and contributes to advancements in comprehending the acquisition and representation of fracture patterns in human bone.

Photo-Cross-Linked Fullerene-Based Hole Transport Material for Moisture-Resistant Regular Fullerene Sandwich Perovskite Solar Cells.

Despite the high efficiencies currently achieved with perovskite solar cells (PSCs), the need to develop stable devices, particularly in humid conditions, still remains. This study presents the synthesis of a novel photo-cross-linkable fullerene-based hole transport material named FT12. For the first time, the photo-cross-linking process is applied to PSCs, resulting in the preparation of photo-cross-linked FT12 (PCL FT12). Regular PSCs based on C60-sandwich architectures were fabricated using FT12 and PCL FT12 as dopant-free hole transport layers (HTLs) and compared to the reference spiro-OMeTAD. The photovoltaic results demonstrate that both FT12 and PCL FT12 significantly outperform pristine spiro-OMeTAD regarding device performance and stability. The comparison between devices based on FT12 and PCL FT12 demonstrates that the photo-cross-linking process enhances device efficiency. This improvement is primarily attributed to enhanced charge extraction, partial oxidation of the HTL, increased hole mobility, and improved layer morphology. PCL FT12-based devices exhibit improved stability compared to FT12 devices, primarily due to the superior moisture resistance achieved through photo-cross-linking.

Smartfeeding: A Dynamic Strategy to Increase Nutritional Efficiency in Critically Ill Patients-Positioning Document of the Metabolism and Nutrition Working Group and the Early Mobilization Working Group of the Catalan Society of Intensive and Critical Care Medicine (SOCMiC).

Adequate medical nutrition therapy for critically ill patients has an impact on their prognoses. However, it requires an individualized approach that takes into account the activity (phases of metabolic stress) and particularity of these patients. We propose a comprehensive strategy considering the patients' nutritional status and the set of modifiable circumstances in these patients, in order to optimize/support nutritional efficiency: (1) A detailed anamnesis and an adequate initial nutritional assessment must be performed in order to implement medical nutrition therapy that is in line with the needs and characteristics of each patient. Furthermore, risks associated with refeeding syndrome, nutritrauma or gastrointestinal dysfunction must be considered and prevented. (2) A safe transition between nutrition therapy routes and between health care units will greatly contribute to recovery. The main objective is to preserve lean mass in critically ill patients, considering metabolic factors, adequate protein intake and muscle stimulation. (3) Continuous monitoring is required for the successful implementation of any health strategy. We lack precise tools for calculating nutritional efficiency in critically ill patients, therefore thorough monitoring of the process is essential. (4) The medical nutrition approach in critically ill patients is multidisciplinary and requires the participation of the entire team involved. A comprehensive strategy such as this can make a significant difference in the functional recovery of critically ill patients, but leaders must be identified to promote training, evaluation, analysis and feedback as essential components of its implementation, and to coordinate this process with the recognition of hospital management.

Considerations for medical nutrition therapy management of the critically ill patient with hematological malignancies: A narrative review.

Patients with hematological malignancies (HMs) are more frequently admitted now than in the past to the intensive care unit (ICU) due to more aggressive approaches in primary therapy of HMs and the need for critical care support. Pathophysiological alterations derived from HMs and the different hematological therapies, such as chemotherapy, negatively affect gastrointestinal (GI) function, metabolism, and nutrition status. Further, malnutrition strongly influences outcomes and tolerance of the different hematological therapies. In consequence, these critically ill patients frequently present with malnutrition and pathophysiological alterations that create challenges for the delivery of medical nutrition therapy (MNT) in the ICU. Frequent screening, gauging tolerance, and monitoring nutrition status are mandatory to provide individualized MNT and achieve nutrition objectives. The present review discusses how HM impact GI function and nutrition status, the importance of MNT in patients with HM, and specific considerations for guidance in providing adequate MNT to these patients when admitted to the ICU.

N-terminal pro-B-type natriuretic peptide post-discharge monitoring in the management of patients with heart failure and preserved ejection fraction - a randomized trial: The NICE study.

AIMS: There is a lack of specific studies assessing the impact of natriuretic peptide monitoring in the post-discharge management of patients with heart failure (HF) and preserved ejection fraction (HFpEF), throughout the vulnerable phase following acute HF hospitalization. The NICE study aims to assess the clinical benefit of incorporating N-terminal pro-B-type natriuretic peptide (NT-proBNP) into the post-discharge management of HFpEF patients. METHODS AND RESULTS: Individuals admitted with HFpEF (left ventricular ejection fraction >50%) were included in a multicentre randomized controlled study employing an open-label design with event blinding (NCT02807168). Upon discharge, 157 patients were randomly allocated to either NT-proBNP monitoring (n = 79) or no access to NT-proBNP (control group, n = 78) during pre-scheduled visits at 2, 4 and 12 weeks. Clinical endpoints were evaluated at 6 months. The primary endpoint of HF rehospitalizations occurred in 12.1% patients, without significant differences observed between the NT-proBNP monitoring group (12.8%) and the control group (11.4%) (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.47-2.81, p = 0.760). Regarding secondary endpoints, the NT-proBNP monitoring group demonstrated a significantly lower risk of death (1.3% vs. 10.1%; HR 0.12, 95% CI 0.02-0.98; p = 0.048), whereas non-HF hospitalizations (12.8% vs. 19.0%, p = 0.171) and any adverse clinical event (26.9% vs. 36.7%, p = 0.17) did not reach statistical significance [Correction added on 29 April 2024, after first online publication: In the preceding sentence, "95% CI 0.02 - 0.09" has been corrected to "95% CI 0.02 - 0.98; p = 0.048" in this version.]. Awareness of NT-proBNP levels were associated with higher doses of diuretics and renin-angiotensin system inhibitors (angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers) in the NT-proBNP monitoring group. CONCLUSIONS: Post-discharge monitoring of NT-proBNP in HFpEF patients did not exhibit an association with reduced rates of HF hospitalization in this study. Nonetheless, it appears to enhance global clinical management by optimizing medical therapies and contributing to improved overall survival.

Biobased Composites of Poly(Lactic Acid) Melt Compounded with Bacterial and Vegetal Nanocelluloses Incorporated through Different Strategies.

In the current contribution, bacterial nanocellulose obtained from a by-product of Kombucha tea production and vegetal nanocellulose isolated from milled rice husks were employed as fillers of PLA-based composites prepared by intensive mixing followed by compression molding. Given the challenges associated with the incorporation of nanocelluloses-initially obtained as aqueous suspensions-into melt compounding processes, and also with achieving a proper dispersion of the hydrophilic nanofillers within PLA, three different nanofibrils incorporation strategies were studied: i.e., direct mixing of dried milled nanocelluloses and PLA; masterbatching by solvent casting of native nanocelluloses followed by melt compounding; and masterbatching by solvent casting of acetylated nanocelluloses followed by melt compounding. Composites with varying filler content (from 0.5 wt.% to 7 wt.%) were characterized in terms of morphology, optical properties, and mechanical performance. Results revealed the relative suitability of each strategy employed to promote nanocelluloses dispersion within the PLA matrix. PLA/nanocellulose masterbatches prepared by solvent casting proved to be particularly useful for feeding the nanocelluloses into the processing equipment in a dry state with limited hornification. Acetylation also contributed to a better dispersion of both nanocelluloses within the PLA matrix, although no clear positive impact on the mechanical properties of the films was observed. Finally, filler loading played an important role in the films' properties by increasing their stiffness while reducing their translucency.

Qualidade de sono e saúde mental de universitários da área da saúde durante a covid-19 / Sleep quality and mental health of university students in healthcare during COVID-19 / Calidad del sueño y salud mental de estudiantes universitarios en el ámbito salud durante el covid-19

Em universitários, comprometimentos na qualidade de sono e na saúde mental estão relacionados com maior disfunção diurna e menor desempenho acadêmico. O contexto causado pela covid-19 prejudicou a qualidade de sono e a saúde mental de diversos grupos populacionais. Entretanto, mais estudos são necessários para avaliar essas variáveis em estudantes universitários matriculados em diferentes cursos da área da saúde durante a referida pandemia. Com esta pesquisa, objetivou-se avaliar a qualidade de sono e saúde mental de estudantes universitários da área da saúde durante a pandemia da covid-19, bem como investigar possíveis correlações entre os referidos aspectos nessa população. Trata-se de estudo transversal que empregou um formulário eletrônico contendo tanto perguntas para caracterização da amostra quanto questionários específicos. O índice de qualidade de sono de Pittsburgh (PSQI) foi empregado para avaliar a qualidade de sono. Já o questionário de saúde geral (QSG-12) e a escala hospitalar de ansiedade e depressão (HAD) para avaliar, respectivamente, o bem-estar psicológico e ansiedade e depressão. 324 estudantes da área da saúde participaram deste estudo. Entre eles, 87.3% apresentaram uma qualidade de sono pobre (≥ 5), 74.1% apresentaram prejuízo na saúde mental e 73.7% apresentaram quadro de ansiedade possível ou provável. Além disso, evidenciou-se correlação moderada positiva entre os valores do PSQI, do QSG-12 e da escala HAD. Nesse contexto, estudos são necessários para investigar opções terapêuticas capazes de atenuar esses impactos.

In university students, sleep quality and mental health impairments are related to greater daytime dysfunction and lower academic performance. COVID-19 has harmed the quality of sleep and mental health of several population groups. However, more studies are needed to evaluate the quality of sleep and mental health of university students enrolled in health courses during the COVID-19 pandemic. To evaluate the quality of sleep and mental health of university students in healthcare during the COVID-19 pandemic and to investigate possible correlations between the aforementioned aspects in this population. An electronic form containing questions to characterize its sample and other specific questionnaires were used in this cross-sectional study. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality and the General Health Questionnaire (QSG-12) and the Hospital Anxiety and Depression Scale (HAD) were used to evaluate psychological well-being, anxiety, and depression, respectively. Overall, 324 health students participated in this study. Of these, 87.3% of students had poor sleep quality (≥ 5), 74.1% had impaired mental health, and 73.7% had possible or probable anxiety. Furthermore, the PSQI, QSG-12, and HAD scale values showed a moderately positive correlation. During the COVID-19 pandemic, university students in healthcare experienced significant losses in their sleep quality and mental health. In this context, studies must investigate therapeutic options to mitigate these impacts.

Las alteraciones en la calidad del sueño y la salud mental de estudiantes universitarios se relacionan con una mayor disfunción diurna y menor rendimiento académico. El contexto provocado por el covid-19 ha perjudicado la calidad del sueño y la salud mental de varios grupos de la población. Sin embargo, se necesitan más estudios para evaluar la calidad del sueño y la salud mental de estudiantes universitarios matriculados en diferentes carreras de salud durante la pandemia del covid-19. El objetivo de este estudio fue evaluar la calidad del sueño y la salud mental de estudiantes universitarios en el campo de la salud durante la pandemia del covid-19, así como investigar posibles correlaciones entre los aspectos antes mencionados en esta población. Se trata de un estudio transversal que utilizó un formulario electrónico que contenía preguntas para caracterizar la muestra y cuestionarios específicos. Se utilizó el Índice de Calidad del Sueño de Pittsburg (PSQI) para evaluar la calidad del sueño. El Cuestionario de Salud General (CSG-12) y la Escala Hospitalaria de Ansiedad y Depresión (HADS) se utilizaron para evaluar, respectivamente, el bienestar psicológico y la ansiedad y depresión. En este estudio participaron 324 estudiantes del campo de la salud. De estos, el 87,3% de los estudiantes tenía mala calidad del sueño (≥ 5), el 74,1% presentaban problemas de salud mental y el 73,7% tenía posible o probable ansiedad. Además, hubo una correlación positiva moderada entre los valores de las escalas PSQI, CSG-12 y HADS. Durante la pandemia del covid-19, los estudiantes universitarios del campo de la salud experimentaron pérdidas significativas en su calidad de sueño y salud mental. En este contexto, son necesarios estudios que investiguen opciones terapéuticas capaces de mitigar estos impactos.

Africanized honey bee colonies in Costa Rica: first evidence of its management, brood nest structure and factors associated with varroa mite infestation.

Management, brood nest structure and factors associated with varroa mite infestation were studied in 60 apiaries of Africanized honey bees in the northwest region of the Central Valley of Costa Rica. Apiaries were monitored two times. The first monitoring was taken forward during the rainy season between May and November 2019. The second monitoring during the dry season between February and March 2020. Information about the beekeepers, apiaries and management was collected through a survey. Amount of open and capped brood, honey and pollen were measured in the field. The infestation rate of varroa (IRV) was quantified using standard laboratory methods. A determination of multi-residue pesticides in bee bread was made through GC-MS/MS and LC-MS/MS techniques. According to the results, most of the beekeepers produce honey (96.7%), participate in training activities (82.2%), and change the bee queens annually (70%). The first monitoring was characterized by a lower amount of capped brood and honey reserves compared to the second one. IRV was significantly higher in the first monitoring (6.0 ± 0.4) in comparison with the second one (3.0 ± 0.3) (U Mann-Whitney p < 0.001). The maximum value for the first monitoring exceeds 40%, while this value was close to 25% in the second monitoring. Mite infestation exposed significant differences in relation to the variables associated to the beekeeper's management, i.e., change of bee queen (p = 0.002) or when beekeepers monitor varroa mites (p = 0.004). Additionally, the IRV had inverse correlations (p < 0.01) with the number of comb sides with capped brood (Spearman's rho coefficient = - 0.190), and honey reserves (Spearman's rho coefficient = - 0.168). Furthermore, 23 of 60 bee bread samples presented one to five pesticide residues, being the most frequent antifungal agrochemicals.

Enteral nutrition in septic shock: a call for a paradigm shift.

PURPOSE OF REVIEW: The purpose of this review is to identify contemporary evidence evaluating enteral nutrition in patients with septic shock, outline risk factors for enteral feeding intolerance (EFI), describe the conundrum of initiating enteral nutrition in patients with septic shock, appraise current EFI definitions, and identify bedside monitors for guiding enteral nutrition therapy. RECENT FINDINGS: The NUTRIREA-2 and NUTRIREA-3 trial results have better informed the dose of enteral nutrition in critically ill patients with circulatory shock. In both trials, patients with predominant septic shock randomized to receive early standard-dose nutrition had more gastrointestinal complications. Compared to other contemporary RCTs that included patients with circulatory shock, patients in the NUTRIREA-2 and NUTRIREA-3 trials had higher bowel ischemia rates, were sicker, and received full-dose enteral nutrition while receiving high baseline dose of vasopressor. These findings suggest severity of illness, vasopressor dose, and enteral nutrition dose impact outcomes. SUMMARY: The provision of early enteral nutrition preserves gut barrier functions; however, these benefits are counterbalanced by potential complications of introducing luminal nutrients into a hypo-perfused gut, including bowel ischemia. Findings from the NUTRIREA2 and NUTRIREA-3 trials substantiate a 'less is more' enteral nutrition dose strategy during the early acute phase of critical illness. In the absence of bedside tools to guide the initiation and advancement of enteral nutrition in patients with septic shock, the benefit of introducing enteral nutrition on preserving gut barrier function must be weighed against the risk of harm by considering dose of vasopressor, dose of enteral nutrition, and severity of illness.

Multicentre randomised trial of screening with sFlt1/PlGF and planned delivery to prevent pre-eclampsia at term: protocol of the PE37 study.

INTRODUCTION: Pre-eclampsia affects ~5%-7% of pregnancies. Although improved obstetric care has significantly diminished its associated maternal mortality, it remains a leading cause of maternal morbidity and mortality in the world. Term pre-eclampsia accounts for 70% of all cases and a large proportion of maternal-fetal morbidity related to this condition. Unlike in preterm pre-eclampsia, the prediction and prevention of term pre-eclampsia remain unsolved. Previously proposed approaches are based on combined third-trimester screening and/or prophylactic drugs, but these policies are unlikely to be widely implementable in many world settings. Recent evidence shows that the soluble fms-like tyrosine kinase-1 (s-Flt-1) to placental growth factor (PlGF) ratio measured at 35-37 weeks' gestation predicts term pre-eclampsia with an 80% detection rate. Likewise, recent studies demonstrate that induction of labour beyond 37 weeks is safe and well accepted by women. We hypothesise that a single-step universal screening for term pre-eclampsia based on sFlt1/PlGF ratio at 35-37 weeks followed by planned delivery beyond 37 weeks reduces the prevalence of term pre-eclampsia without increasing the caesarean section rates or worsening the neonatal outcomes. METHODS AND ANALYSIS: We propose an open-label randomised clinical trial to evaluate the impact of a screening of term pre-eclampsia with the sFlt-1/PlGF ratio followed by planned delivery in asymptomatic nulliparous women at 35-37 weeks. Women will be assigned 1:1 to revealed (sFlt-1/PlGF known to clinicians) versus concealed (unknown) arms. A cut-off of >90th centile is used to define the high risk of subsequent pre-eclampsia and offer planned delivery from 37 weeks. The efficacy variables will be analysed and compared between groups primarily following an intention-to-treat approach, by ORs and their 95% CI. This value will be computed using a Generalised Linear Mixed Model for binary response (study group as fixed effect and the centre as intercept random effect). ETHICS AND DISSEMINATION: The study is conducted under the principles of Good Clinical Practice. This study was accepted by the Clinical Research Ethics Committee of Hospital Clinic Barcelona on 20 November 2020. Subsequent approval by individual ethical committees and competent authorities was granted. The study results will be published in peer-reviewed journals and disseminated at international conferences. TRIAL REGISTRATION NUMBER: NCT04766866.

Population pharmacokinetics and humanized dosage regimens matching the peak, area, trough, and range of amikacin plasma concentrations in immune-competent murine bloodstream and lung infection models.

Amikacin is an FDA-approved aminoglycoside antibiotic that is commonly used. However, validated dosage regimens that achieve clinically relevant exposure profiles in mice are lacking. We aimed to design and validate humanized dosage regimens for amikacin in immune-competent murine bloodstream and lung infection models of Acinetobacter baumannii. Plasma and lung epithelial lining fluid (ELF) concentrations after single subcutaneous doses of 1.37, 13.7, and 137 mg/kg of body weight were simultaneously modeled via population pharmacokinetics. Then, humanized amikacin dosage regimens in mice were designed and prospectively validated to match the peak, area, trough, and range of plasma concentration profiles in critically ill patients (clinical dose: 25-30 mg/kg of body weight). The pharmacokinetics of amikacin were linear, with a clearance of 9.93 mL/h in both infection models after a single dose. However, the volume of distribution differed between models, resulting in an elimination half-life of 48 min for the bloodstream and 36 min for the lung model. The drug exposure in ELF was 72.7% compared to that in plasma. After multiple q6h dosing, clearance decreased by ~80% from the first (7.35 mL/h) to the last two dosing intervals (~1.50 mL/h) in the bloodstream model. Likewise, clearance decreased by 41% from 7.44 to 4.39 mL/h in the lung model. The humanized dosage regimens were 117 mg/kg of body weight/day in mice [administered in four fractions 6 h apart (q6h): 61.9%, 18.6%, 11.3%, and 8.21% of total dose] for the bloodstream and 96.7 mg/kg of body weight/day (given q6h as 65.1%, 16.9%, 10.5%, and 7.41%) for the lung model. These validated humanized dosage regimens and population pharmacokinetic models support translational studies with clinically relevant amikacin exposure profiles.

The demographic history and adaptation of Canarian goat breeds to environmental conditions through the use of genome-wide SNP data.

BACKGROUND: The presence of goats in the Canary Islands dates back to the late 1st millennium BC, which coincides with the colonization by the Amazigh settlers. However, the exact geographic origin of Canarian goats is uncertain since the Amazigh peoples were distributed over a wide spatial range. Nowadays, three Canarian breeds (Palmera, Majorera and Tinerfeña) are officially recognized, along with two distinct South and North Tinerfeña ecotypes, with the South Tinerfeña and Majorera goats thriving in arid and dry semi-desertic environments and the Palmera and North Tinerfeña goats are adapted to humid and temperate areas that are influenced by trade winds. Genotypes for 224 Canarian goats were generated using the Illumina Goat single nucleotide polymorphism (SNP)50 BeadChip. By merging these data with the genotypes from 1007 individuals of African and Southern European ancestry, our aim was to ascertain the geographic origin of the Canarian goats and identify genes associated with adaptation to diverse environmental conditions. RESULTS: The diversity indices of the Canarian breeds align with most of those of the analyzed local breeds from Africa and Europe, except for the Palmera goats that showed lower levels of genetic variation. The Canarian breeds demonstrate a significant genetic differentiation compared to other populations, which indicates a history of prolonged geographic isolation. Moreover, the phylogenetic reconstruction indicated that the ancestry of the Canarian goats is fundamentally North African rather than West African. The ADMIXTURE and the TreeMix analyses showed no evidence of gene flow between Canarian goats and other continental breeds. The analysis of runs of homozygosity (ROH) identified 13 ROH islands while the window-based FST method detected 25 genomic regions under selection. Major signals of selection were found on Capra hircus (CHI) chromosomes 6, 7, and 10 using various comparisons and methods. CONCLUSIONS: This genome-wide analysis sheds new light on the evolutionary history of the four breeds that inhabit the Canary Islands. Our findings suggest a North African origin of the Canarian goats. In addition, within the genomic regions highlighted by the ROH and FST approaches, several genes related to body size and heat tolerance were identified.