Prehospital Lactate Levels Obtained in the Ambulance and Prediction of 2-Day In-Hospital Mortality in Patients With Traumatic Brain Injury.

BACKGROUND AND OBJECTIVES: To analyze the ability of prehospital lactate levels to predict 2-day in-hospital mortality in patients with traumatic brain injury (TBI), severe TBI (Glasgow Coma Scale (GCS) ≤ 8 points), and mild or moderate TBI (GCS ≥ 9 points). Second, 90-day mortality was also explored. METHODS: This was a prospective, multicenter, emergency medical services (EMSs) delivery, ambulance-based, derivation-validation cohort study developed in 5 tertiary hospitals (Spain), from November 1, 2019, to July 31, 2022. Patients were recruited from among all phone requests for emergency assistance among adults who were later evacuated to referral hospitals with acute TBI. The exclusion criteria were minors, pregnancy, trauma patients without TBI, delayed presentations, patients were discharged in situ, participants with cardiac arrest, and unavailability to obtain a blood sample. The primary outcome was all-cause 2-day in-hospital mortality and 90-day mortality in patients with moderate or mild TBI compared with patients with severe TBI. Clinical and analytical parameters (lactate and glucose) were collected. The discriminative power (area under the receiver operating characteristic curve [AUC]) and calibration curve were calculated for 2 geographically separated cohorts. RESULTS: A total of 509 patients were ultimately included. The median age was 58 years (interquartile range: 43-75), and 167 patients were female (32.8%). The primary outcome occurred in 9 (2.2%) of 415 patients with moderate or mild TBI and in 42 (44.7%) of 94 patients with severe TBI. The predictive capacity of the lactate concentration was globally validated in our cohort, for which the AUC was 0.874 (95% CI 0.805-0.942) for the validation cohort. The ability of the GCS score to predict lactate concentration was greater in patients with a GCS score ≥9 points, with an AUC of 0.925 (95% CI 0.808-1.000) and a negative predictive value of 99.09 (95% CI 98.55-99.64) in the validation cohort. CONCLUSION: Our results show the benefit of using lactate in all patients with TBI, particularly in those with a GCS ≥9 points. Routine incorporation of lactate in the screening of patients with TBI could presumably reduce mortality and deterioration rates because of quicker and better identification of patients at risk.

[Ligamentous and meniscal injuries of the pediatric knee joint]. / Ligamentäre und meniskale Verletzungen am kindlichen Kniegelenk.

Intraligamentous injuries to the anterior cruciate ligament (ACL) and meniscus injuries are rare in children and adolescents and often occur as a result of sports injuries. Clinically, they usually present as a hemarthrosis. The diagnosis of choice is the MRI examination. Surgical treatment of intraligamentary ACL injuries using the transphyseal technique is now also the gold standard treatment for children and adolescents, leg axis and length checks are necessary after surgery until growth is complete. Meniscus injuries are also addressed surgically. Postoperative follow-up treatment and rehabilitation are particularly important in order to prevent reinjury. The disc meniscus is a special entity and is also treated surgically if it is symptomatic. Isolated collateral ligament and posterior cruciate ligament ruptures are rarities.

The Effects of Eccentric Training on Undulatory Underwater Swimming Performance and Kinematics in Competitive Swimmers.

This study aimed to evaluate the effects of a five-week training program on undulatory underwater swimming (UUS) in swimmers and to compare the specific effects prompted by two different training protocols on UUS performance and kinematics. Swimmers (n = 14) were divided into in-water only (WO) (18.61 ± 2.62 years, FINA points: 507 ± 60) and water + dry-land training groups (with conical pulleys) (WD) (18.38 ± 2.67 years, FINA points: 508 ± 83). Three countermovement jumps (CMJ) and three maximal UUS trials were performed before and after a five-week training period. The training program comprised 14 × 30-min sessions. The WO group repeated the same 15-min block twice, while the WD group performed one block of 15 min in the water and the other block on land performing lower limb exercises with conical pulleys. Seven body landmarks were auto-digitalized during UUS by a pre-trained neural network and 21 kinematic variables were calculated. The level of statistical significance was set at p < 0.05. Significant time × group interaction in favour of the WD group was observed for mean vertical toe velocity (p = 0.035, η p 2 = 0.32). The WD group experienced enhancements in mean and maximum underwater velocity, kick frequency, maximum shoulder angular velocity, as well as mean and maximum vertical toe velocity (p < 0.05). The WO group exhibited an enhancement in CMJ height (p < 0.05). In conclusion, UUS performance was improved in adolescent swimmers after five weeks of specific training, only when combining water and conical pulley exercises. Coaches should include dry-land specific lower limb exercises in addition to in-water training to improve UUS performance.

Eye tracking study in children to assess mental calculation and eye movements.

Eye tracking technology is a high-potential tool for different mathematic cognition research areas. Moreover, there is a dire need for more studies that provide detailed information on the quality of registered eye data. This study aimed to illustrate the applicability of eye tracking in the examination of mathematical cognition, focusing specifically on primary school students completing a computerized mental arithmetic task. Results suggested that the eye tracking device effectively captured high-quality eye movement data when primary school children engaged in this specific task. Furthermore, significant negative correlations have been found between task performance and number of eye fixations. Finally, eye movements distinctions between "Areas of Interest" have been found, indicating different visual tracking associated with different components of arithmetic calculations. This study underscores the extensive possibilities for future research employing eye tracking devices during computerized calculation tasks as assessment tools to explore the complex visual and cognitive processes.

Rituximab-induced cystoid macular edema in a patient with systemic lupus erythematosus: A case report and literature review.

Cystoid macular edema (CME) is considered a rare adverse effect of rituximab use, with only a limited number of cases published in the literature. Although its etiopathogenesis is still unknown, its mechanism seems to be related to a transient elevation of cytokines after rituximab infusion resulting in an increased permeability of retinal vessels. We report the first case of rituximab-induced CME in a patient with systemic lupus erythematosus (SLE), where rituximab was used to treat hematological complications. A month after the 2nd infusion, the patient developed blurred vision and decreased visual acuity in the right eye. An optic coherence tomography (OCT) was performed, being diagnosed with CME. Rituximab was then discontinued, exhibiting a complete resolution of the condition within 4 weeks. The aim of our work is to report the first case in a patient with SLE and also carry out a brief review of the subject comparing it to all previously published cases.

Symmetry-Guided Engineering of Polarization by 2D Moiré Metasurfaces.

Cylindrical vector (CV) beams exhibit spatially varying polarization important in optical communication, super-resolution microscopy, and high-throughput information processing. Compared to radially or azimuthally polarized CV beams that are cylindrically symmetric, hybrid-electric (HE) beams offer increased optical tunability because of their polygonally symmetric polarizations. However, efforts to generate and isolate HE beams have relied on bulky optical assemblies or devices with complex and stringent fabrication requirements. Here, we report a moiré-based metasurface approach to engineer HE polarization states with high degrees of rotational symmetry. Importantly, polarization symmetries can be tailored based only on the reciprocal lattice of the metasurface and not the real-space patterns. Our modular method outlines important design principles for shaping light at the nanoscale.

Diabetic foot ulcers: evaluating the role of the specialist advanced practice nurse in complex chronic wounds.

OBJECTIVES: To determine the profile of diabetes patients with neuropathic and neuro-ischaemic lesions who are referred to the advanced practice nurse (APN) in complex chronic wounds; to determine whether a training strategy aimed at primary care nurses and nursing homes that care for patients with diabetic foot disease influences the performance of professionals; and to assess the extent, follow-up and evaluation of diabetic foot disease in patients with neuropathic ulcers and neuro-ischaemic ulcers referred to the specialist APN before and after the training. METHODS: The characteristics of patients referred to the APN over a period of 6.5 years were analysed, as well as the numbers of amputations and deaths pre- and post-training. RESULTS: of the total of 103 patients, 78 were men; across both sexes the average age was 69 years. Fifty patients had neuropathic ulcers and 53 had neuro-ischaemic ulcers, with healing rates of 59%. There were 50 amputations and 37 deaths over the study period. CONCLUSION: Prevention of diabetic foot ulcers depends on having in place a fast, agile, practical clinical pathway between primary care and hospital, with the role of the APN, including the co-ordination of care between primary and secondary settings, being key.

Acute effects of apnea bouts on hemoglobin concentration and hematocrit: a systematic review and meta-analysis.

Objective: This study aimed to systematically analyze the existing literature and conduct a meta-analysis on the acute effects of apnea on the hematological response by assessing changes in hemoglobin (Hb) concentration and hematocrit (Hct) values. Methods: Searches in Pubmed, The Cochrane Library, and Web of Science were carried out for studies in which the main intervention was voluntary hypoventilation, and Hb and Hct values were measured. Risk of bias and quality assessments were performed. Results: Nine studies with data from 160 participants were included, involving both subjects experienced in breath-hold sports and physically active subjects unrelated to breath-holding activities. The GRADE scale showed a "high" confidence for Hb concentration, with a mean absolute effect of 0.57 g/dL over control interventions. "Moderate" confidence appeared for Hct, where the mean absolute effect was 2.45% higher over control interventions. Hb concentration increased to a greater extent in the apnea group compared to the control group (MD = 0.57 g/dL [95% CI 0.28, 0.86], Z = 3.81, p = 0.0001) as occurred with Hct (MD = 2.45% [95% CI 0.98, 3.93], Z = 3.26, p = 0.001). Conclusions: Apnea bouts lead to a significant increase in the concentration of Hb and Hct with a high and moderate quality of evidence, respectively. Further trials on apnea and its application to different settings are needed.

Swimming Performance in Elite Triathletes: Comparison Between Open Water and Pool Conditions.

This study aimed to compare performance, kinematic, and physiological variables between open water and pool swimming conditions in elite triathletes and to examine the associations between conditions on these variables. Fourteen elite triathletes (10 males and 4 females [23.4 ± 3.8 years]) performed two 1500-m swimming tests in open water and in a 25-m pool. Swimming speed, stroke rate (SR), length (SL) and index (SI), heart rate (HR), blood lactate concentrations [La-], and end-exercise oxygen uptake (EEV̇O2) were assessed in both conditions. Lower SL and SI and higher SR were obtained in open water compared with pool swimming (p < 0.05). Moreover, kinematic variables changed as a function of distance in both conditions (p < 0.05). No differences were found in the main physiological variables (HR, [La-], and EEV̇O2) between conditions. Respiratory exchange ratio presented lower values in open water than in pool conditions (p < 0.05), while time constant was higher in open water (p = 0.032). The fastest triathletes in open water obtained the best performance in the pool (r = 0.958; p < 0.001). All kinematic variables, HR and peak [La-] presented positive associations between conditions (r > 0.6; p < 0.05). Despite physiological invariance, triathletes and coaches should monitor specific open water training to adapt their swimming technique to the competitive environment.

Extraction and Depolymerization of Lignin from Different Agricultural and Forestry Wastes to Obtain Building Blocks in a Circular Economy Framework.

Large amounts of agri-food waste are generated and discarded annually, but they have the potential to become highly profitable sources of value-added compounds. Many of these are lignin-rich residues. Lignin, one of the most abundant biopolymers in nature, offers numerous possibilities as a raw material or renewable resource for the production of chemical products. This study aims to explore the potential revalorization of agricultural by-products through the extraction of lignin and subsequent depolymerization. Different residues were studied; river cane, rice husks, broccoli stems, wheat straw, and olive stone are investigated (all local wastes that are typically incinerated). Traditional soda extraction, enhanced by ultrasound, is applied, comparing two different sonication methods. The extraction yields from different residues were as follows: river cane (28.21%), rice husks (24.27%), broccoli (6.48%), wheat straw (17.66%), and olive stones (24.29%). Once lignin is extracted, depolymerization is performed by three different methods: high-pressure reactor, ultrasound-assisted solvent depolymerization, and microwave solvolysis. As a result, a new microwave depolymerization method has been developed and patented, using for the first time graphene nanoplatelets (GNPs) as new promising carbonaceous catalyst, achieving a 90.89% depolymerization rate of river cane lignin and yielding several building blocks, including guaiacol, vanillin, ferulic acid, or acetovanillone.

Identification of Benzodiazepine Use Based on Dried Blood Stains Analysis.

Biological matrices are typically used in forensic toxicological or pharmacological analysis: mainly blood, vitreous humor or urine. However, there are many cases in which crimes are a consequence of drug intoxication or drug abuse and they are not closed because over the months or years the samples become altered or decomposed. A dried blood stains test (DBS-MS) has recently been proposed to be used in drug toxicology when blood is found at a crime scene. This test could help an investigator to reveal what a person had consumed before the perpetration of the crime. In order to check the possibilities of this test, we analyzed several dried blood stains located on a cotton fabric. Therefore, the aim of this study was to determine if the analysis of a dried blood spot located on a cotton fabric could be an alternate source of obtaining toxicological results, particularly regarding benzodiazepines. We splashed blood stains on cotton fabric with different concentrations of the following benzodiazepines: alprazolam, bromazepam, clonazepam, diazepam and lorazepam, which were dried for 96 h and subsequently quantified by high-performance liquid chromatography coupled mass spectrometry (HPLC-MS). Our results show that it is possible to identify several benzodiazepines contained in a cotton fabric blood stain; consequently, this method may add another sample option to the toxicological analysis of biological vestiges found at a crime scene.

Assessing the impact of long-term inhaled corticosteroid therapy on patients with COVID-19 and coexisting chronic lung disease: A multicenter retrospective cohort study.

Background: Patients with chronic lung disease (CLD), such as asthma or chronic obstructive pulmonary disease, were expected to have an increased risk of clinical manifestations and severity of COVID-19. However, these comorbidities have been reported less frequently than expected. Chronic treatment with inhaled corticosteroids (ICS) may impact the clinical course of COVID-19. The main objective of this study is to know the influence of chronic treatment with ICS on the prognosis of COVID-19 hospitalized patients with CLD. Methods: A multicenter retrospective cohort study was designed, including patients hospitalized with COVID-19. Epidemiological and clinical data were collected at admission and at seven days, and clinical outcomes were collected. Patients with CLD with and without chronic treatment with ICS were compared. Results: Two thousand five hundred ninety-eight patients were included, of which 1,171 patients had a diagnosis of asthma and 1,427 of COPD (53.37% and 41.41% with ICS, respectively). No differences were found in mortality, transfer to ICU, or development of moderate-severe ARDS. Patients with chronic ICS had a longer hospital stay in both asthma and COPD patients (9 vs. 8 days, p = 0.031 in asthma patients), (11 vs. 9 days, p = 0.018 in COPD patients); although they also had more comorbidity burden. Conclusions: Patients with chronic inhaled corticosteroids had longer hospital stays and more chronic comorbidities, measured by the Charlson comorbidity index, but they did not have more severe disease at admission, evaluated with qSOFA and PSI scores. Chronic treatment with inhaled corticosteroids had no influence on the prognosis of patients with chronic lung disease and COVID-19.

Room-Temperature Polariton Lasing from CdSe Core-Only Nanoplatelets.

This paper reports how CdSe core-only nanoplatelets (NPLs) coupled with plasmonic Al nanoparticle lattices can exhibit exciton-polariton lasing. By improving a procedure to synthesize monodisperse 4-monolayer CdSe NPLs, we could resolve polariton decay dynamics and pathways. Experiment and theory confirmed that the system is in the strong coupling regime based on anticrossings in the dispersion diagrams and magnitude of the Rabi-splitting values. Notably, polariton lasing is observed only for cavity lattice periodicities that exhibit specific dispersive characteristics that enable polariton accumulation. The threshold of polariton lasing is 25-fold lower than the reported photon lasing values from CdSe NPLs in similar cavity designs. This open-cavity platform offers a simple approach to control exciton polaritons anticipated to benefit quantum information processing, optoelectronics, and chemical reactions.

Big five personality traits, gaming motives, and regular and disordered gaming: A cross-national examination among college student gamers in seven countries.

INTRODUCTION: Previous research has shown that personality traits and gaming motives are important predictors for explaining regular and disordered gaming. However, the mediating role of gaming motives in the relation between personality traits and video game outcomes (e.g., time spent gaming or disordered gaming) has been scarcely studied and limited cross-national studies have addressed this issue. The present study aimed to examine the direct and indirect effects of the Big Five personality traits on weekly gaming and disordered gaming via gaming motives across seven countries. METHOD: 3540 college student gamers (59.5% women) from the U.S., Canada, Spain, Argentina, Uruguay, South Africa and England completed the online survey. Structural equation modeling was conducted to test models. Multigroup models were employed to test model invariance across countries. RESULTS: Significant, albeit weak, relations were found between personality traits and gaming outcomes, and were mediated mostly by coping motives in predicting disordered gaming, and by social interaction and recreation (to a lesser extent) motives in predicting weekly gaming. Some minor, yet significant, differences across countries appeared and are discussed in detail. DISCUSSION: The present findings indicate that the differential interrelations between personality traits, gaming motives, and video gaming outcomes may be generalized in college students across countries.

Sentinel lymph node biopsy versus observation in high-risk cutaneous squamous cell carcinoma in immunosuppressed and immunocompetent patients: An inverse probability of treatment weighting study.

BACKGROUND: The survival benefit of sentinel lymph node biopsy (SLNB) in immunocompetent and immunosuppressed patients with high-risk cutaneous squamous cell carcinoma (cSCC) has not been established. OBJECTIVE: To determine whether SLNB improves disease-specific survival (DSS) in high-risk cSCC. Secondary objectives were to analyse disease-free survival, nodal recurrence-free survival and overall survival (OS). METHODS: Multicentre, retrospective, observational cohort study comparing survival outcomes in immunosuppressed and immunocompetent patients treated with SLNB or watchful waiting. Inverse probability of treatment weighting was used to adjust for possible confounding effects. RESULTS: We studied 638 tumours in immunocompetent patients (SLNB n = 42, observation n = 596) and 173 tumours in immunosuppressed patients (SLNB n = 28, observation n = 145). Overall, SLNB was positive in 15.7% of tumours. SLNB was associated with a reduced risk of nodal recurrence (NR) (hazard ratio [HR], 0.05 [95% CI, 0.01-0.43]; p = 0.006), disease specific mortality (HR, 0.17 [95% CI, 0.04-0.72]; p = 0.016) and all-cause mortality (HR, 0.33 [95% CI, 0.15-0.71]; p = 0.004) only in immunocompetent patients. CONCLUSIONS: SLNB was associated with improvements in NR, DSS and OS in immunocompetent but not in immunosuppressed patients with high-risk cSCC.

Relationships among Physical Fitness, External Loads, and Heart Rate Recovery: A Study on Futsal Players during an Overseas Congested-Weeks Training Camp.

This study examined relationships among players' physical characteristics, match external loads, and heart rate recovery (HRR) during match substitutions in a congested fixture of an overseas futsal training camp. Eleven under-20 national futsal players' anthropometric characteristics (age, body height, body mass, % fat, and % muscle) and physical fitness [HRmax, VO2max, maximal aerobic speed (MAS) during the 30-15 intermittent fitness test (IFT)] were determined. Additionally, locomotion profiles during field play and HRR sitting on the bench were recorded during five matches. A repeated-measures analysis of variance and Pearson's correlation coefficient were used for statistical analysis. The results revealed that the overall observed correlations among anthropometry, body composition, physical fitness, and HRR were inconsistent across all the matches and substitutions. However, the numbers of moderate (1.00-1.99 m/s2), moderate-to-high (2.00-2.99 m/s2), and high (3.00-50.00 m/s2) intensities of acceleration presented negative correlations in the last match (r < -0.76; p < 0.05). HRR during match substitutions may have been influenced by uncontrolled factors across all the match play and recovery. HRR measures may be affected mainly by fatigue caused by the accumulation of accelerations throughout a congested fixture during a congested-schedule of a futsal training camp.

Editorial for Special Issue 'Engineering and Characterisation of Novel Nanomedicine Formulations'.

Nanomedicine is the application of nanotechnology to achieve innovations in healthcare and involves the engineering of systems at the nanoscale (particle size < 1000 nm) with the aim of improving drug delivery [...].

Characterization of Quaternary-Ammonium-Based Ionogel Membranes for Application in Proton Exchange Membrane Fuel Cells.

In recent years, the quest to advance fuel cell technologies has intensified, driven by the imperative to reduce reliance on hydrocarbon-derived fuels and mitigate pollutant emissions. Proton exchange membranes are a critical material of fuel cell technologies. The potential of ionic liquid-based polymer inclusion membranes or ionogels for proton exchange membrane fuel cells (PEMFCs) has recently appeared. Thermal stability, SEM-EDX characterization, NMR and IR characterization, thermogravimetric analysis, ion exchange capacity, and water uptake are key properties of these membranes which need to be investigated. In this work, ionogel based on quaternary ammonium salts, such as [N8,8,8,1+][Cl-], [N8,8,8,1+][Br-], and [N8-10,8-10,8-10,1+][Cl-] in various compositions with poly(vinyl chloride) are extensively studied and characterized based on those key properties. The best properties were obtained when a quaternary ammonium cation was combined with a bromide anion. Finally, ionogels are tested in microbial fuel cells. Microbial fuel cells based on the ionogel reach a maximum of 147 mW/m2, which represents 55% of the reference membrane (Nafion 212). These results indicate that we still have the possibility of improvement through the appropriate selection of the cation and anion of the ionic liquid. Overall, the promise of ionogel membranes as a viable alternative in fuel cell applications has been demonstrated.

Endovascular treatment in Danon disease: a case report.

BACKGROUND: Danon disease is a lysosomal storage disorder with X-linked inheritance. The classic triad is severe hypertrophic cardiomyopathy, myopathy, and intellectual disability, with different phenotypes between both genders. Ischemic stroke is an uncommon complication, mostly cardioembolic, related to intraventricular thrombus or atrial fibrillation, among others. CASE REPORT: We report the case of a 14-year-old Caucasian male patient with Danon disease who suffered from an acute ischemic stroke due to occlusion in the M1 segment of the middle cerebral artery. He underwent mechanical thrombectomy, resulting in successful revascularization with satisfactory clinical outcome. We objectified the intraventricular thrombus in the absence of arrhythmic events. CONCLUSION: To our knowledge, we report the first case of ischemic stroke related to Danon disease treated with endovascular treatment.

Open Water Swimming in Elite Triathletes: Physiological and Biomechanical Determinants.

This study aimed (i) to analyze the 1500 m open water swimming performance, (ii) to examine the associations between physiological and biomechanical variables with swimming performance, and (iii) to determine which variables can predict swimming performance in triathletes. Fourteen elite triathletes (23.4±3.8 y) performed a 1500 m test in open water swimming conditions. Swimming performance was assessed using World Aquatics Points Scoring, and data were obtained from the 1500 m open water swimming test. Heart rate, end-exercise oxygen uptake (EE˙VO2) and blood lactate concentrations were measured. The initial 250 m of the 1500 m swimming test presented the highest values of biomechanical variables in males (i. e. swimming speed, stroke rate (SR), length (SL), index (SI)). A decrease in SL was observed in the last 250 m in both sexes. Positive association were found between EE˙VO2 (r=0.513; p=0.030), swimming speed (r=0.873; p<0.001) and SI (r=0.704; p=0.002) with swimming performance. In contrast, time constant of the oxygen uptake (r=-0.500; p=0.034) and buoy-turn times (r=-0.525; p=0.027) were negatively associated with performance. SI was the main predictor (R 2=0.495) of open water swimming performance in triathletes. In conclusion, triathletes and coaches must conduct open water training sessions to maximize SI (i. e. swimming efficiency).