Bacillus subtilis biofilm matrix components target seed oil bodies to promote growth and anti-fungal resistance in melon.

Beneficial microorganisms are used to stimulate the germination of seeds; however, their growth-promoting mechanisms remain largely unexplored. Bacillus subtilis is commonly found in association with different plant organs, providing protection against pathogens or stimulating plant growth. We report that application of B. subtilis to melon seeds results in genetic and physiological responses in seeds that alter the metabolic and developmental status in 5-d and 1-month-old plants upon germination. We analysed mutants in different components of the extracellular matrix of B. subtilis biofilms in interaction with seeds and found cooperation in bacterial colonization of seed storage tissues and growth promotion. Combining confocal microscopy with fluorogenic probes, we found that two specific components of the extracellular matrix, amyloid protein TasA and fengycin, differentially increased the concentrations of reactive oxygen species inside seeds. Further, using electron and fluorescence microscopy and metabolomics, we showed that both TasA and fengycin targeted the oil bodies in the seed endosperm, resulting in specific changes in lipid metabolism and accumulation of glutathione-related molecules. In turn, this results in two different plant growth developmental programmes: TasA and fengycin stimulate the development of radicles, and fengycin alone stimulate the growth of adult plants and resistance in the phylloplane to the fungus Botrytis cinerea. Understanding mechanisms of bacterial growth promotion will enable the design of bespoke growth promotion strains.

Apoyos sanitarios externos requeridos durante la mision Enhanced Forward Presence III (Letonia) / External health supports required during Enhanced Forward Presence III mission (Latvia)

ANTECEDENTES Y OBJETIVOS: En julio de 2016 se dio luz verde a la operacion eFP (Enhanced Forward Presence), con el objetivo de proveer de defensa a los paises balticos miembros de la OTAN, frente a Rusia. Espana desplego un contingente en Letonia, cuya sanidad la compuso una celula de estabilizacion y un enfermero de enlace. En caso de necesitar apoyos sanitarios se acordo hacer uso del ROLE 1 canadiense o los servicios sanitarios civiles letones. El objetivo de este estudio fue analizar los apoyos sanitarios externos requeridos durante la mision Enhanced Forward Presence III. MATERIAL Y MÉTODOS: Se llevo a cabo un estudio transversal. Se utilizaron los 78 casos de la mision eFP-III en los que hubo que gestionar apoyo externo. El analisis estadistico se llevó a cabo a traves del GNU PSPP Statistical Analysis Software version 1.2.0-g0fb4db. RESULTADOS: Los resultados se expresaron en frecuencias. Se hallo relacion significativa entre el tipo de apoyo requerido y el tipo de medios (militares o civiles) utilizados para su resolucion. El apoyo más numeroso fue el odontologico, seguido del radiodiagnostico y de la fisioterapia. El mayor número de apoyos correspondió a hombres, escala Militares Profesionales de Tropa y Marineria, resueltos por medios militares y en una unica consulta. Los medios militares resolvieron la mayoria de los casos para los que contaron con la especialidad concreta necesaria

ANTECEDENT AND OBJECTIVES: In July 2016, the eFP (Enhanced Forward Presence) operation was given a green light, with the aim of providing defense to the Baltic countries members of NATO, against Russia. Spain deployed a contingent in Latvia, whose health consisted of a stabilization cell and a liaison nurse. In case of needing health support, it was agreed to use the Canadian ROLE 1 or the latvian civil health services. The objective of this study was to analyze the external health support required during the Enhanced Forward Presence III mission. MATERIAL AND METHODS: A cross-sectional study was carried out. The 78 cases of the eFP-III mission were used in which external support had to be managed. Statistical analysis was carried out through the GNU PSPP Statistical Analysis Software version 1.2.0-g0fb4db. RESULTS: The results were expressed in frequencies. A significant relationship was found between the type of support required and the type of means (military or civil) used to resolve it. The most numerous support was the dentist, followed by radiodiagnosis and physiotherapy. The largest number of support corresponded to men, Professional Military Troop and Maritime scale, resolved by military means and in a single consultation. The military media resolved most of the cases for which they had the necessary concrete specialty

Pas Kinase Deficiency Triggers Antioxidant Mechanisms in the Liver.

Metabolic dysfunction in the liver is the cause of numerous pathologies, which are associated with an altered redox state. PASK (PAS Domain Kinase) is a nutrient and bioenergetic sensor. We contend that PASK could act as an oxidative stress sensor in liver and/or control the metabolic balance, playing a role in the mitochondrial homeostasis. Using PASK-deficient mice, we observed that PASK deficiency promotes antioxidant response mechanisms: a lower production of ROS/RNS under non-fasting conditions, overexpression of genes coding to ROS-detoxifying enzymes and mitochondrial fusion proteins (MnSod Gpx, Mfn1 and Opa1), coactivator Ppargc1a, transcription factors (Pparg and FoxO3a) and deacetylase Sirt1. Also, under fasting conditions, PASK deficiency induced the overexpression of Ppargc1a, Ppara, Pparg, FoxO3a and Nrf2 leading to the overexpression of genes coding to antioxidant enzymes such as MnSOD, Cu/ZnSOD, GPx, HO1 and GCLm. Additionally, inducing PINK1 involved in cell survival and mitophagy. These changes kept ROS steady levels and improved the regenerative state. We suggest a new role for PASK as a controller of oxidative stress and mitochondrial dynamics in the liver. In fact, antioxidant response is PASK dependent. PASK-targeting could therefore be a good way of reducing the oxidative stress in order to prevent or treat liver diseases.

PAS Kinase deficiency alters the glucokinase function and hepatic metabolism.

The liver controls metabolic homeostasis in response to fasting and refeeding periods. Glucokinase (GCK) adjusts hepatic glucose phosphorylation to blood glucose levels, acting as a glucose sensor. Our objective was to determine whether PAS kinase (PASK), a nutrient sensor, could be affecting the expression or activity of liver GCK and the response to fasting and refeeding states of key hepatic metabolic pathways. PASK-deficient mice have impaired insulin signaling (AKT overactivation). Furthermore, PASK deficiency modified the expression of several transcription factors involved in the adjustment to fasting and refeeding. Foxo1 decreased under fasting conditions, while Ppara and Pparg were overexpressed in PASK-deficient mice. However, PEPCK protein levels were similar or higher, while the expression of Cpt1a decreased in PASK-deficient mice. By contrast, Lxra and Chrebp were overexpressed after refeeding, while the expression of Acc and Fas decreased in PASK-deficient mice. Likewise, with a decreased expression of Gck and increased nuclear location of the complex GCK-GCKR, GCK activity decreased in PASK-deficient mice. Therefore, PASK regulated some of the genes and proteins responsible for glucose sensing, such as glucokinase, and for insulin signalling, affecting glucose and lipid metabolism and consequently certain critical hepatic functions.

Differentiation of fibrotic liver tissue using laser-induced breakdown spectroscopy.

Hepatic cirrhosis is a major cause of morbidity and mortality worldwide due to hepatitis C, alcoholism and fatty liver disease associated with obesity. Assessment of hepatic fibrosis relies in qualitative histological evaluation of biopsy samples. This method is time-consuming and depends on the histopathologists' interpretation. In the last decades, non-invasive techniques were developed to detect and monitor hepatic fibrosis. Laser-induced breakdown spectroscopy (LIBS) is a good candidate for a real-time, independent and fast technique to diagnose hepatic fibrosis. In this work LIBS was employed to characterize rat liver tissues with different stages of fibrosis. Depth profiling measurements were carried out by using a nanosecond Nd:YAG laser operated at the fundamental wavelength and an echelle spectrometer coupled with an ICCD camera. Due to the soft nature of the samples, plasma conditions largely change between consecutives shots. Thus, a theoretically supported procedure to correct the spectral line intensities was implemented. This procedure allows the reduction of the intensities' dispersion from 67% to 12%. After the correction, the LIBS signal shows an enhancement in calcium intensity by a factor of three as the fibrosis progressed. Calcium is known to increase crosslinking of extracellular matrix proteins in the fibrous septa. Therefore, our result singles it out as a key participant in the hepatic fibrosis.

[Epidemiological surveillance for multidrug-resistant microorganisms in a general ICU]. / Vigilancia epidemiológica para microorganismos multirresistentes en una UCI polivalente.

OBJECTIVE: Multidrug resistant (MDR) microorganisms represent a threat for patients admitted in Intensive Care Units (ICUs). The objective of the present study is to analyse the results of epidemiological surveillance cultures for these microorganisms in one of these units. METHODS: General ICU. Retrospective analysis, descriptive statistics. Analysis of epidemiological surveillance cultures for MDR microorganisms in 2015. Studied microorganisms: Methicillin-resistant Staphylococcus aureus (MRSA), ESBL-and/or carbapenemase-producing Klebsiella pneumoniae (CESBL-KP) and MDR Acinetobacter baumannii (MDRAB). RESULTS: One thousand, two hundred and fifty nine patients admitted. A total of 2,234 specimens from 384 patients were analysed (690, 634, 62 and 286 were rectal, throat, nasal and skin swabs respectively). Global APACHE II was 18.3 ± 8 versus 21.7 ± 7.8 in patients colonized/infected on admission. Global mortality was 19.7% versus 22.3% in patients colonized/infected on admission. The higher sensitivities achieved with the different samples for the different microorganism detection were as follows. MRSA: 79% and 90% for nasal and nasal + throat swabs, respectively. MDRAB: 80% and 95% for throat and throat + rectal swabs, respectively. CESBL-KP: 95% and 98% for rectal and rectal + throat swabs, respectively. 94 out of the 384 patients (24.4%) were colonized/infected with MDR at admission. 134 patients (10.6% of the total patients admitted) were colonized/infected with a total of 169 MMR during the hospital stay. MRSA has the earliest colonization/infection (9.2 ± 6.4days) and ESBL-producing Enterobacteriaceae, the latest (18.7± 16.4 days). CONCLUSIONS: 24.4% of patients were colonized/infected by MDR at admission. Nasal, throat and rectal swabs were the most effective specimens for recovering MRSA, MDRAB and CESBL-KP, respectively. The combination of two specimens improves MDR detection except for CESBL-KP. Skin swabs are worthless. The most prevalent MDR at admission were ESBL-producing Enterobacteriaceae while the most frequent hospital acquired MDR was MDRAB..

Enterococcal bloodstream infection. Design and validation of a mortality prediction rule.

BACKGROUND: To develop a prediction rule to describe the risk of death as a result of enterococcal bloodstream infection. METHODS: A prediction rule was developed by analysing data collected from 122 patients diagnosed with enterococcal BSI admitted to the Clínica Universidad de Navarra (Pamplona, Spain); and validated by confirming its accuracy with the data of an external population (Hospital del Mar, Barcelona). RESULTS: According to this model, independent significant predictors for the risk of death were being diabetic, have received appropriate treatment, severe prognosis of the underlying diseases, have renal failure, received solid organ transplant, malignancy, source of the bloodstream infection and be immunosuppressed. The prediction rule showed a very good calibration (Hosmer-Lemeshow statistic, P = 0.93) and discrimination for both training and testing sets (area under ROC curve = 0.84 and 0.83 respectively). CONCLUSIONS: The predictive rule was able to predict risk of death as a result of enterococcal bloodstream infection as well as to identify patients, who being below the threshold value, will have a low risk of death with a negative predictive value of 96%.

[Personal resources relevant to psychological well-being in nursing]. / Recursos personales relevantes para el bienestar psicológico en el personal de enfermería.

AIMS: To determine differences in social support, resilience, coping, and psychological well-being (PWB) among intensive care nursing and nursing staff of other hospital services, as well as to establish a structural model in these professionals where relevant personal resources to PWB were included. METHOD: Correlational and cross-sectional study. A sample of 208 nursing professionals from University Hospital of Fuenlabrada (Madrid) took part in the study. This sample consisted of nurses (n=133), nursing assistants (n=61), and midwives (n=14), of whom 44 worked in intensive care unit, 50 in other special units, and 114 in wards. INSTRUMENTS: Social Support Subscale, 10-Item CD-RISC (resilience), Brief-Cope (coping), Scales of PWB, and sociodemographic variables. RESULTS: No differences were found in any assessed psychological variables as regards hospital service worked in. A structural model was found and showed that social support, resilience, and coping determined PWB of nursing professionals. The most important personal resource was coping strategies, which determined PWB directly (ß=0.68). Social support influenced PWB directly (ß=0.33), and indirectly (ß=0.32), whereas resilience influenced it indirectly (ß=0.57). CONCLUSIONS: Differences in PWB, coping, social support and resilience are not determined by hospital service. Coping strategies focused on engagement (or adaptive), social support, and resilience, constitute three relevant personal resources that determine the PWB of nursing staff, which can be developed and improved by specific programs. The most important PWB dimensions are self-acceptance and environment mastery.

Comparative Genomics Within the Bacillus Genus Reveal the Singularities of Two Robust Bacillus amyloliquefaciens Biocontrol Strains.

Bacillus amyloliquefaciens CECT 8237 and CECT 8238, formerly known as Bacillus subtilis UMAF6639 and UMAF6614, respectively, contribute to plant health by facing microbial pathogens or inducing the plant's defense mechanisms. We sequenced their genomes and developed a set of ad hoc scripts that allowed us to search for the features implicated in their beneficial interaction with plants. We define a core set of genes that should ideally be found in any beneficial Bacillus strain, including the production of secondary metabolites, volatile compounds, metabolic plasticity, cell-to-cell communication systems, and biofilm formation. We experimentally prove that some of these genetic elements are active, such as i) the production of known secondary metabolites or ii) acetoin and 2-3-butanediol, compounds that stimulate plant growth and host defense responses. A comparison with other Bacillus genomes permits us to find differences in the cell-to-cell communication system and biofilm formation and to hypothesize variations in their persistence and resistance ability in diverse environmental conditions. In addition, the major protection provided by CECT 8237 and CECT 8238, which is different from other Bacillus strains against bacterial and fungal melon diseases, permits us to propose a correlation with their singular genetic background and determine the need to search for additional blind biocontrol-related features.

Predictors of mortality and poor outcome in cancer patients with E. faecium bloodstream infection.

BACKGROUND: To analyze predictors of mortality and poor outcome in cancer patients diagnosed with E. faecium bloodstream infection. METHODS: Demographic, clinical and microbiological data were collected (January 1998-June 2011). RESULTS: After multivariate analysis, presence of a urinary catheter was associated with a worse 7-day prognosis, and higher mortality at discharge. A high Charlson index was also associated with higher 7-day mortality. CONCLUSION: Presence of a urinary catheter was associated with poor 7-day prognosis and higher mortality at discharge in the present series.

Predictors of mortality and poor outcome in cancer patients with E. faecium bloodstream infection / Predictores de mortalidad y mal pronóstico en el paciente oncológico con bacteriemia enterocócica

Background: To analyze predictors of mortality and poor outcome in cancer patients diagnosed with E. faecium bloodstream infection. Methods: Demographic, clinical and microbiological data were collected (January 1998-June 2011). Results: After multivariate analysis, presence of a urinary catheter was associated with a worse 7-day prognosis, and higher mortality at discharge. A high Charlson index was also associated with higher 7-day mortality. Conclusion: Presence of a urinary catheter was associated with poor 7-day prognosis and higher mortality at discharge in the present series (AU)

Fundamento: Analizar los predictores de mortalidad y mal pronóstico en el paciente oncológico diagnosticado de bacteriemia por E. faecium. Métodos: Se analizaron datos demográficos, clínicos y microbiológicos (Enero 1998-Junio 2011). Resultados: El análisis multivariable demostró que la presencia de una sonda urinaria se asoció a mal pronóstico a los 7 días y alta mortalidad del paciente al final del estudio. Un índice de Charlson elevado se asoció a un aumento en la mortalidad a los 7 días. Conclusión: En nuestro estudio, la presencia de sonda urinaria se asoció con mal pronóstico del paciente a los 7 días y aumento de la mortalidad (AU)

Single-stage reconstruction of flexor tendons with vascularized tendon transfers.

The reconstruction of finger flexor tendons with vascularized flexor digitorum superficialis (FDS) tendon grafts (flaps) based on the ulnar vessels as a single stage is not a popular technique. We reviewed 40 flexor tendon reconstructions (four flexor pollicis longus and 36 finger flexors) with vascularized FDS tendon grafts in 38 consecutive patients. The donor tendons were transferred based on the ulnar vessels as a single-stage procedure (37 pedicled flaps, three free flaps). Four patients required composite tendon and skin island transfer. Minimum follow-up was 12 months, and functional results were evaluated using a total active range of motion score. Multiple linear regression analysis was performed to evaluate the factors that could be associated with the postoperative total active range of motion. The average postoperative total active range of motion (excluding the thumbs) was 178.05° (SD 50°). The total active range of motion was significantly lower for patients who were reconstructed with free flaps and for those who required composite tendon and skin island flap. Age, right or left hand, donor/motor tendon and pulley reconstruction had no linear effect on total active range of motion. Overall results were comparable with a published series on staged tendon grafting but with a lower complication rate. Vascularized pedicled tendon grafts/flaps are useful in the reconstruction of defects of finger flexor tendons in a single stage, although its role in the reconstructive armamentarium remains to be clearly established.

[Is subjective well-being perceived by non-health care workers different from that perceived by nurses? Relation with personality and resilience]. / El bienestar subjetivo percibido por los profesionales no sanitarios ¿es diferente al de enfermería de intensivos? Relación con personalidad y resiliencia.

Subjective well-being (SWB), usually called 'happiness', is influenced directly by psychological factors. Personality and resilience (capacity of recover from adversity) are included among these factors. Empirical evidence has demonstrated that resilience is an essential and inherent characteristic for the nursery staff. This study has aimed to analyze personality factors (including resilience) related with SWB (satisfaction with life, positive and negative affect) in a nursery staff sample (n=59) of intensive care and cardiological units, and a non-health care workers sample (n=50) mainly made up of government employees and teachers. Multiple regression analyses showed that SWB was associated with more resilience and less neuroticism in the nursery staff. Extraversion and conscientiousness (positively related), and neuroticism (negatively related) were the significant predictors of SWB in the non-health care workers group. Finally, mediational analyses revealed that resilience measured the relationships between extraversion (total mediation) and neuroticism (partial mediation) with SWB in the nursery staff group, but not in the group of non-health care workers. The results show the importance of resilience for nursery staff of intensive care units, since they are constantly exposed to human suffering and to a continually adverse occupational environment. Likewise, the discussion stresses that resilience is a means for nursing staff to cope with the occupational stress and that resilient nurses are a crucial element in our health care system.

Coping strategies, depressive symptoms and quality of life in hypertensive patients: mediational and prospective relations.

This study examined whether depressive symptoms mediated the association between coping strategies and quality of life (QoL) in a sample of hypertensive patients, and the prospective contribution of depressive symptoms and coping strategies in the prediction of their QoL. One hundred and fifty patients (50% males and 50% females) with a diagnosis of essential hypertension were recruited from a general hospital. Symptoms of depression, coping and QoL measures (global score and dimensions) were collected at baseline. Sixty-three participants completed the QoL questionnaire again one year later (T2). The results indicated that the relations between emotion coping and QoL (global score, satisfaction and social support) were totally mediated by depressive symptoms. The association between emotion coping and well-being was, however, partially mediated by depressive symptoms. Furthermore, only baseline instrumental coping strategies predicted higher levels of QoL (global score, well-being and social support) at T2. Neither emotion coping nor depressive symptoms were significantly associated with prospective QoL. These findings suggest that depressive symptoms may be a mechanism linking the manner in which patients cope with their hypertension and their QoL. They also emphasise the adaptive role played by instrumental coping responses in the management of hypertension in the long term.

Colgajo de omento para tratamiento de dehiscencia de herida esternal / Omental flap for management of sternal wound dehiscence

La mediastinitis es una de las complicaciones más graves de la cirugía cardíaca. Aparece en el 0,5-5% de las esternotomías y esta incidencia es mucho mayor en pacientes diabéticos, obesos, inmunodeprimidos, con enfermedad pulmonar obstructiva crónica (EPOC), etc. Presentamos el caso de una paciente diabética, obesamórbida, que sufre mediastinitis tras doble by-pass coronario. Para la cobertura del defecto se empleó un colgajo de epiplon tunelizado transdiafragmático. El colgajo omental permite cubrir grandes defectos además de que posee capacidad antimicrobiana y favorece la revascularización tisular. Las características de este colgajo hacenque actualmente deba considerarse como primera elección en pacientes con grandes defectos esternales y trastornos de la inmunidad y la cicatrización (AU)

Mediastinitis is one of the most serious complications from cardiac surgery. It is reported to occur in 0’5-5% of sternotomy incisions, and this incidence is much higher in diabetic patients, obese, immunocompromised, COPD, etc. We report a case of a diabetic and morbid obese woman suffering mediastinitis after double coronary bypass surgery. For the reconstruction a transdiaphragmatictunnelled omental flap was used. The omentum isuseful to cover large defects. It has antiinfective properties and promotes revascularization of neighboring tissues. Omental flap can be a highly effective treatment for patients with large sternal wounds and immune disorders and wound healing disorders(AU)

Pautas para el uso de terapia de vacío en el Servicio de Cirugía Plástica del Hospital La Fe en Valencia (España) / Use of vacuum therapy in the Plastic Surgery Department Hospital La Fe, Valencia (Spain)

El tratamiento de heridas complejas, con pérdida de sustancia importante o exposición de estructuras nobles, constituye una práctica diaria en la mayoría de los Servicios de Cirugía Plástica de referencia. A pesar de que el desbridamiento quirúrgico continúa siendo la terapia de elección para el tratamiento de heridas infectadas o con abundantes restos necróticos, el advenimiento de la terapia de vacío y las mejoras tecnológicas experimentadas por dicha terapia en la última década, hacen de su utilización una herramienta coadyuvante para el control del lecho quirúrgico, de los exudados de la herida y de la colonización bacteriana. Presentamos 9 casos clínicos de uso de terapia VAC® en el tratamiento de diversas patologías, tales como: dehiscencia esternal, grandes quemados, traumatismos de extremidades, etc. En todos ellos, esta terapia constituyó un pilar fundamental en el tratamiento de los pacientes facilitando el control del exudado de las heridas, la protección de estructuras nobles y mejorando la calidad de vida y el confort de los pacientes durante su estancia hospitalaria (AU)

Treatment of complex wounds that imply loss of substance or important anatomic structures exposure has a great relevance in Plastic Surgery Departments nowadays. Even though surgical debridement keeps on being the principal choice treatment in infected or necrotic wounds, VAC® therapy use and its new technology advances in the last decade, has allowed an option to control bacterial colonization, exudates and surgical wounds. We present 9 cases of vacuum therapy use for treatment of different pathologies such as sternum dehiscence, burned patients, extremities trauma, etc. In all these cases vacuum therapy has been essential in the management of exudates, protection of anatomic vital structures as well as to improve patient's quality of life during hospital stay (AU)

Uso de terapia de vacío en el Hospital Infantil La Fe de Valencia (España): experiencia y resultados / Experience and results with the use of vacuum assisted therapy at the children’s Hospital La Fe, Valencia (Spain)

El uso de la terapia de vacío en el tratamiento de heridas complejas y de evolución tórpida tiene sus inicios en los años cuarenta. Sin embargo, la experiencia con su utilización en la población infantil es mucho más reciente. En la actualidad no disponemos de estudios científicos contrastados y con nivel de evidencia A para emitir conclusiones firmes en estos casos; a pesar de ello, la experiencia clínica acumulada hasta el momento es satisfactoria en la mayoría de los casos. En la gestión sanitaria moderna, el control de recursos y costes es hoy en día un pilar fundamental; es por ello que contar con una terapia de estas características constituye un recurso de gran valor, sobre todo cuando la intención es minimizar la estancia hospitalaria y a la vez mejorar la calidad de vida del paciente, lo cual es especialmente importante cuando se trata de niños. Presentamos la experiencia en el uso de terapia de vacío en pacientes pediátricos del Servicio de Cirugía Plástica y Reconstructiva del Hospital La Fe de Valencia, España, entre los años 2007 y 2010 (AU)

Vacuum assisted therapy in complex and complicated wounds has been used since the 40s; however, it has only been applied in paediatric patients recently. To our best knowledge there are not A level evidence studies in this field, although experience in its use has been shown to be satisfactory in the majority of cases. Due to the importance in health management of controlling costs and resources, this therapy represents a useful tool, specially when we try to reduce hospital stay and improve quality of life, which is very important in children. We report our experience in the use of vacuum therapy in paediatric patients in the Plastic and Reconstructive Surgery Department in La Fe University Hospital, Valencia, Spain, between 2007 and 2010 (AU)