Lessons learned in implementing a multidisciplinary long COVID clinic.

The diagnosis and treatment of long COVID patients is challenging. Our aim is to share lessons learned using a multidisciplinary approach within the Veterans Affairs system. Our long COVID clinic is based in primary care but has imbedded rehabilitations specialists, nutrition. whole health and different specialists within internal medicine. We conduct an extensive work-up to evaluate the presence of end-organ damage, ongoing inflammation and dysautonomia. Our treatments are based on the prior experience that the VA system has on chronic fatigue syndrome and gulf war illness.

Association Between High-Sensitivity C-Reactive Protein and Metabolic Syndrome Among Hispanic/Latino Participants of the Hispanic Community Health Study/Study of Latinos.

Purpose: To determine whether high-sensitivity C-reactive protein (hsCRP) is associated with incident Metabolic Syndrome (MetS) among U.S. Hispanic/Latino adults. Patients and Methods: The Hispanic Community Health Study/Study of Latinos is a longitudinal observational cohort assessing cardiovascular health among diverse U.S. Hispanic/Latino adults. hsCRP was measured at visit 1 (2008-2011) and classified as low, moderate, or high, based on the Centers for Disease Control and Prevention and American Heart Association (CDC/AHA) guidelines. All MetS components [abdominal obesity, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and fasting glucose] were measured at visit 1 and visit 2 (2014-2017). MetS was defined as the presence of three or more components based on the 2005 definition from the modified Third Report of the National Cholesterol Education Program Adult Treatment Panel (modified NCEP ATP III). Participants free of MetS at visit 1 and with complete data on hsCRP and all MetS components were included (n = 6121 participants). We used Poisson regression analysis to determine whether hsCRP was associated with incident MetS after adjusting for demographic, behavioral, and clinical factors. All analyses accounted for the complex survey design of the study. Results: In fully adjusted models, moderate versus low hsCRP was associated with a 33% increased risk of MetS [incidence rate ratio (IRR): 1.33, 95% confidence interval (CI): 1.10-1.61], while high versus low hsCRP was associated with a 89% increased risk of MetS (IRR: 1.89, 95% CI: 1.58-2.25). Conclusions: Greater levels of hsCRP were associated with new onset of MetS in a diverse sample of U.S. Hispanic/Latino adults. Results suggest that hsCRP may be an independent risk factor for MetS.

Low-dose Naltrexone Improves post-COVID-19 condition Symptoms.

PURPOSE: Treatments for myalgic encephalomyelitis and chronic fatigue syndrome can be adapted for post-COVID-19 condition. Our aim was to compare treatments in patients from our post-COVID-19 clinic. METHODS: We conducted a retrospective cohort study and included consecutive patients enrolled in our post-COVID-19 clinic. We included patients who received low-dose naltrexone, amitriptyline, duloxetine, and physical therapy, and evaluated improvements in fatigue, pain, dyspnea, and brain fog recorded in the electronic health record. We calculated the adjusted relative hazard of improvement using Cox proportional models. We adjusted for demographic characteristics, comorbidities, and prior COVID-19 hospitalization. FINDINGS: We included the first 108 patients with post-COVID-19 enrolled in the clinic. Most of the patients received amitriptyline. The relative hazard of improvement for those taking low-dose naltrexone was 5.04 (95% CI, 1.22-20.77; P = 0.02) compared with physical therapy alone. Both fatigue and pain were improved in patients taking low-dose naltrexone; only fatigue was improved in patients taking amitriptyline. IMPLICATIONS: Post-COVID-19 condition symptoms may improve in patients taking medications adapted from myalgic encephalomyelitis and chronic fatigue syndrome. Randomized controlled trials should evaluate these medications and translational studies should further evaluate their mechanisms of action.

Is Prior Zika Virus Infection Associated With Cardiovascular Disease?

BACKGROUND: Zika virus (ZIKV) infection is associated with severe complications. Recently, reports have raised the possibility of cardiovascular complications. However, the complications that are reported are in case reports and occur immediately after infection. Our aim is to evaluate the cardiovascular complications of ZIKV infection in a younger patient population. METHODS: We conducted a prospective cohort and included patients with a one-year history of prior confirmed ZIKV infection. We performed an echocardiogram, a 24-hour automated blood pressure, and a 24-hour Holter. Our primary outcome included a composite of having diastolic dysfunction, left ventricular hypertrophy, arrhythmias, valvular regurgitation, premature beats, or non-dipper status. RESULTS: We included 47 patients with ZIKV and 16 patients without ZIKV. Patients with ZIKV had a similar age as controls (p>0.05). Having had a prior ZIKV infection was associated with diastolic dysfunction, left ventricular hypertrophy, valvular regurgitation, arrhythmias or premature beats, and non-dipper status (p<0.05). The adjusted OR of having the primary outcome was 2.3; 95% CI 1.3-2.7. After one year, IL-10 and C-reactive protein (CRP) were higher in ZIKV-infected patients compared to controls (p<0.05). CONCLUSIONS: Our study found that young patients with a prior ZIKV infection have more echocardiographic, arrhythmic, and blood pressure changes when compared to similar-aged controls.

Peer-to-Patient-Aligned Care Team (Peer-to-PACT; P2P), a Peer-Led Home Visit Intervention Program for Targeting and Improving Long-term Care Services and Support for Veterans With High Needs and High Risk: Protocol for a Mixed Methods Feasibility Study.

BACKGROUND: Keeping older veterans with high needs and high risk (HNHR) who are at risk of long-term institutional care safely in their homes for as long as possible is a Department of Veterans Affairs priority. Older veterans with HNHR face disproportionate barriers and disparities to engaging in their care, including accessing care and services. Veterans with HNHR often have poor ability to maintain health owing to complicated unmet health and social needs. The use of peer support specialists (peers) is a promising approach to improving patient engagement and addressing unmet needs. The Peer-to-Patient-Aligned Care Team (Peer-to-PACT; P2P) intervention is a multicomponential home visit intervention designed to support older veterans with HNHR to age in place. Participants receive a peer-led home visit to identify unmet needs and home safety risks aligned with the age-friendly health system model; care coordination, health care system navigation, and linking to needed services and resources in collaboration with their PACT; and patient empowerment and coaching using Department of Veterans Affairs whole health principles. OBJECTIVE: The primary aim of this study is to evaluate the preliminary effect of the P2P intervention on patient health care engagement. The second aim is to identify the number and types of needs and unmet needs as well as needs addressed using the P2P needs identification tool. The third aim is to evaluate the feasibility and acceptability of the P2P intervention delivered over 6 months. METHODS: We will use a quantitative-qualitative convergent mixed methods approach to evaluate the P2P intervention outcomes. For our primary outcome, we will conduct an independent, 2-tailed, 2-sample t test to compare the means of the 6-month pre-post differences in the number of outpatient PACT encounters between the intervention and matched comparison groups. Qualitative data analysis will follow a structured rapid approach using deductive coding as well as the Consolidated Framework for Implementation Research. RESULTS: Study enrollment began in July 2020 and was completed in March 2022. Our sample size consists of 114 veterans: 38 (33.3%) P2P intervention participants and 76 (66.7%) matched comparison group participants. Study findings are expected to be published in late 2023. CONCLUSIONS: Peers may help bridge the gap between PACT providers and veterans with HNHR by evaluating veterans' needs outside of the clinic, summarizing identified unmet needs, and developing team-based solutions in partnership with the PACT. The home visit component of the intervention provides eyes in the home and may be a promising and innovative tool to improve patient engagement. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46156.

Malignant peripheral nerve sheath tumor on a patient with a maternally inherited novel NF1 gene pathogenic germline variant: Case report.

INTRODUCTION: Neurofibromatosis type 1 (NF1) is an autosomal dominant cancer predisposition syndrome caused by pathogenic variants in NF1, which negatively regulates the RAS pathway. Knowledge of the genotype-phenotype correlation in this disease is an important tool for prognostic evaluation and early detection of malignant peripheral nerve sheath tumors (MPNST), present in approximately 10% of these patients. We present the case of a teenager with a left jaw MPNST and a previously unreported germline pathogenic variant on NF1. CASE PRESENTATION: An 11-year-old female with a NF1 clinical diagnosis was referred to our hospital with a MPNST in an advanced state. A previously unreported NF1 pathogenic variant was obtained (GRCh37: NM_182493.2 c.3299C>G, p.Ser1100*). Despite great efforts from the surgical and medical teams, the tumor progression couldn't be halted, resulting in the patient's death. DISCUSSION: As MPNSTs are refractory to current treatment regimens, early diagnosis, and development of new therapies, such as MEK inhibitors, is necessary for reducing morbidity and mortality within NF1 patients. This increases the importance of a more widespread genetic testing strategy. CONCLUSION: The report of a novel NF1 pathogenic variant in a patient with maternally inherited neurofibromatosis type 1 and a MPNST increases the knowledge of the genotype-phenotype correlation in the disease.

Oesophageal Atresia: Prevalence in the Valencian Region (Spain) and Associated Anomalies.

The objective was to determine the prevalence of oesophageal atresia (OA) and describe the characteristics of OA cases diagnosed before the first year of life, born between 2007 and 2019, and residents in the Valencian Region (VR), Spain. Live births (LB), stillbirths (SB), and termination of pregnancy for fetal anomaly (TOPFA) diagnosed with OA were selected from the Congenital Anomalies population-based Registry of VR (RPAC-CV). The prevalence of OA per 10,000 births with 95% confidence interval was calculated, and socio-demographic and clinical variables were analyzed. A total of 146 OA cases were identified. The overall prevalence was 2.4/10,000 births, and prevalence by type of pregnancy ending was 2.3 in LB and 0.03 in both SB and TOPFA. A mortality rate of 0.03/1000 LB was observed. A relationship was found between case mortality and birth weight (p-value < 0.05). OA was primarily diagnosed at birth (58.2%) and 71.2% of the cases were associated with another congenital anomaly, mainly congenital heart defects. Significant variations in the prevalence of OA in the VR were detected throughout the study period. In conclusion, a lower prevalence in SB and TOPFA was identified compared to EUROCAT data. As several studies have identified, an association between OA cases and birth weight was found.

Colorectal Cancer Screening Disparities Among Race: A Zip Code Level Analysis.

BACKGROUND: Colorectal cancer (CRC) screening can prevent disease by early identification. Existing disparities in CRC screening have been associated with factors including race, socioeconomic status, insurance, and even geography. Our study takes a deeper look into how social determinants related to zip code tabulation areas affect CRC screenings. MATERIALS AND METHODS: We conducted a retrospective cross-sectional study of CRC screenings by race at a zip code level, evaluating for impactful social determinant factors such as the social deprivation index (SDI). We used publicly available data from CDC 500 Cities Project (2016-2019), PLACES Project (2020), and the American Community Survey (2019). We conducted multivariate and confirmatory factor analyses among race, income, health insurance, check-up visits, and SDI. RESULTS: Increasing the tertile of SDI was associated with a higher likelihood of being Black or Hispanic, as well as decreased median household income (P < .01). Lower rates of regular checkup visits were found in the third tertile of SDI (P < .01). The multivariate analysis showed that being Black, Hispanic, lower income, being uninsured, lack of regular check-ups, and increased SDI were related to decreased CRC screening. In the confirmatory factor analysis, we found that SDI and access to insurance were the variables most related to decreased CRC screening. CONCLUSION: Our results reveal the top 2 factors that impact a locality's CRC screening rates are the social deprivation index and access to health care. This data may help implement interventions targeting social barriers to further promote CRC screenings within disadvantaged communities and decrease overall mortality via early screening.

Impact of Prediabetes on Cardiac Function Among Primary Care Patients.

Background: Prediabetes is a novel risk factor recently associated with changes in the left ventricle. Our aim is to determine if prediabetes is associated with heart failure (HF) and structural heart disease. Methods: We conducted a cross-sectional study and performed screening echocardiograms to consecutive primary care patients. We calculated the hemoglobin A1c (HbA1c) within 3 months of the echocardiogram and classified patients as having normal glucose, low-risk or high-risk prediabetes or diabetes. Our primary outcome was HF defined as an ejection fraction (EF) <50% and HF with preserved EF. Our secondary outcome was structural heart disease defined as having either a large atrium, left ventricular hypertrophy, or low EF. Results: We included 15,056 patients who underwent a screening echocardiogram and had a recorded HbA1c. Only 2794 patients had a normal blood glucose, 4201 had low-risk prediabetes, 2499 had high-risk prediabetes, and the remainder had diabetes. The adjusted odds ratio (ORs) of HF for low-risk prediabetes, high-risk prediabetes and diabetes were 1.38 [confidence interval (95% CI) 1.07-1.78] (P = 0.01), 1.47 (95% CI 1.05-2.01) (P = 0.01), and 1.60 (95% CI 1.16-2.01) (P < 0.01), respectively, when compared with normoglycemic patients. The adjusted OR of HF with preserved EF for low- and high-risk prediabetes and diabetes were 1.17 (95% CI 0.86-1.60) (P = 0.30), 1.60 (95% CI 1.15-2.21) (P < 0.01), and 1.63 (95% CI 1.24-2.13) (P < 0.01), respectively, when compared with normoglycemic patients. Conclusions: Prediabetes is a prevalent condition associated with structural heart disease and HF.

Access to Health Care Improves COVID-19 Vaccination and Mitigates Health Disparities Among Medicare Beneficiaries.

BACKGROUND: COVID-19 disproportionately impacts the elderly, particularly racial/ethnic minorities and those with low socioeconomic status (SES). These latter groups may also have higher vaccine hesitancy. We aim to evaluate if access to care improves COVID-19 vaccination rates and improves health disparities. METHODS: We conducted a retrospective cohort study of Medicare patients receiving care in a high-touch capitated network across ten states. We collected type and date of COVID-19 vaccine and demographic and clinical data from the inpatient and outpatient electronic health records and socioeconomic status from the US census. Our primary outcome was completing vaccination using logistic regression. RESULTS: Our cohort included 93,224 patients enrolled in the network during the study period. Sixty nine percent of all enrolled patients completed full vaccination. Those who completed vaccination did it with Pfizer (46%), Moderna (49%), and Jannsen (4.6%) vaccines. In adjusted models, we found that the following characteristics increased the odds of being vaccinated: being male, increasing age, BMI, and comorbidities, being Black or Hispanic, having had the flu vaccine in 2020, and increasing number of office primary care visits. Living in a neighborhood with higher social deprivation and having dual Medicaid/Medicare enrollment decreased the odds of completing full vaccination. CONCLUSIONS: Increasing office visit in a high-touch primary care model is associated with higher vaccination rates among elderly populations who belong to racial/ethnic minorities or have low socioeconomic status. However, lower SES and Medicaid populations continue to have difficulty in completing vaccination. KEY POINTS: • High COVID-19 vaccination rates of minorities enrolled in Medicare can be achieved. • Lower socioeconomic status is associated with completing vaccination. • Increasing office visits can lead to higher vaccination rates.

La sistematización de los riesgos en procedimientos estéticos invasivos

Introducción. La cirugía estética tiene un importante reconocimiento en la sociedad contemporánea. Colombia se ubica como uno de los países en el que anualmente se practica un alto número de procedimientos estéticos invasivos; sin embargo, también se ha establecido que esta especialidad presenta frecuentes complicaciones cuyos riesgos necesitan ser registrados y sistematizados. Objetivo: Proponer un modelo adicional de sistematización de riesgos en cirugía estética que fortalezca los comúnmente empleados en Colombia. Metodología: El método utilizado fue el de estrategias de prevención de riesgos aplicadas al ámbito médico, empleando para este trabajo las dos primeras etapas, es decir, la sistematización de fuentes de información a partir de datos obtenidos de la gaceta jurisprudencial publicada por el Tribunal Nacional de Ética Médica y la identificación de la taxonomía de los eventos y errores médicos en cirugía estética. Resultados: En total se analizaron 57 providencias de las gacetas del Tribunal Nacional de Ética Médica sobre cirugía plástica y estética (privilegiando los procedimientos estéticos invasivos), pertenecientes a 2012, 2015 y 2017; de estas 34 cumplieron los criterios de selección; posteriormente, se realizó la sistematización de los riesgos hallados. Conclusiones: El modelo de tecnovigilancia empleado en Colombia resulta insuficiente a la hora de registrar los eventos y errores que se producen en procedimientos estéticos invasivos, por lo que es necesario emplear métodos adicionales que permitan garantizar una mayor seguridad en el paciente, prevenir daños lesivos y disminuir los procesos judiciales en contra del personal sanitario.

Introduction: Plastic surgery has an important place in today's contemporary society. Colombia ranks as one of the countries with the highest annual number of performed invasive esthetic procedures. However, it has been established that this type of special procedures showcases frequent complications and the need to register and systematize risks. Objective: To propose an additional model of risk systematization in cosmetic surgery that strengthens those commonly used in Colombia. Methodology: The method used was that of risk prevention strategies applied to the medical field, using for this work the first two stages, that is, the systematization of sources of information from data obtained from the jurisprudential gazette published by the National Court of Medical Ethics, and the identification of the taxonomy of events and medical errors in esthetic surgery. Results: In total, 57 orders of the National Court of Medical Ethics on plastic and esthetic surgery (favoring invasive esthetic procedures), from 2012, 2015, and 2017, were analyzed, of which 34 met the selection criteria; later, the found risks were systematized. Conclusions: The techno-vigilance model used in Colombia is insufficient to record events and errors that occur in invasive esthetic procedures, so it is necessary to use additional methods to ensure greater patient safety, prevent harm, and reduce judicial proceedings against healthcare personnel.

Peri-event plasma PCSK9 and hsCRP after an acute myocardial infarction correlate with early deterioration of left ventricular ejection fraction: a cohort study.

BACKGROUND: It is important to identify patients at increased risk of worsening of left ventricular ejection fraction (LVEF) after a myocardial infarction (MI). We aimed to identify the association of various potential biomarkers with LVEF impairment after an MI in South American patients. METHODS: We studied adult patients admitted to a University Hospital and diagnosed with an acute MI. Plasma concentrations of high-sensitivity C-reactive protein (hsCRP), proprotein convertase subtilisin/kexin type 9 (PCSK9), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and heart-type fatty-acid-binding protein (FABP3) were determined in samples drawn shortly after the event. Participants had a follow-up visit at least 45 days after the event. The primary endpoint was defined as any decline in LVEF at follow-up relative to baseline. RESULTS: The study included 106 patients (77.4% men, 22.6% women), mean age was 64.1, mean baseline LVEF was 56.6, 19% had a prior MI. We obtained a follow-up evaluation in 100 (94.4%) of participants, mean follow-up time was 163 days. There was a significant correlation between baseline PCSK9 and hsCRP (r = 0.39, p < 0.001). Baseline hsCRP concentrations were higher in patients who developed the endpoint than in those who did not (32.1 versus 21.2 mg/L, p = 0.066). After multivariate adjustment, baseline PCSK9, male sex and age were significantly associated with impairment in LVEF. The absolute change in LVEF was inversely correlated with baseline hsCRP (standardized coefficient = - 0.246, p = 0.004). CONCLUSION: High plasma levels of PCSK9 and hsCRP were associated with early decreases in LVEF after an MI in Latin American patients.

Higher Abdominal Adiposity Is Associated With Lower Muscle Strength in Chilean Adults.

Handgrip strength (HGS) is a well-established indicator of muscle strength and a reasonable clinical predictor of metabolic health and diseases. This study explores the association between relative muscular strength and abdominal obesity (AO) in healthy Chilean adults. A convenience sample was recruited (n = 976) between 2018 and 2020. The HGS was determined by dynamometry. The anthropometry (weight, height, waist, and mid-arm circumference) and physical activity were also measured. The relative HGS (RHGS) was calculated by dividing the maximum HGS of the dominant hand by the body mass index. The AO was defined as a waist circumference (WC) >88 cm for women, and >102 cm for men. From the sample, 52.6% were women, 56.4% had excessive weight, and 42.7% had AO. The absolute and RHGS were greater in men compared to women (p < 0.001) and were decreased with age in both sexes. We observed a moderate negative correlation between WC and RHGS (rho = -0.54, and rho = -0.53, for men and women, respectively). The RHGS was lower in individuals with AO, independent of age and sex (p < 0.05). For each cm increase in WC, the odds of low RHGS (<25th percentile) increased by 12 and 9% for men and women, respectively. The AO is related to higher odds for low RHGS (OR: 1.72; 95% CI: 1.23-2.41). In our sample of healthy adults, a higher AO was associated with a lower muscle strength measured by dynamometry.

Social barriers influence inflammatory bowel disease (IBD) outcomes and disproportionally affect Hispanics and non-Hispanic Blacks with IBD.

Background: The impact of social determinants of health in inflammatory bowel disease (IBD) remains understudied. We evaluated the impact of social barriers on IBD outcomes within a diverse cohort of patients. Methods: We performed a cross-sectional study on adult IBD patients and assessed known social determinants of health. We calculated the total prevalence of these barriers in the sample as a whole and within each ethnic group. We summed the number of barriers present for each individual to create a cumulative social barrier score (SBS), and we evaluated the relationship of each barrier and of the cumulative SBS with IBD outcomes, including disease activity and depressive symptoms. Results: A total of 316 patients were included in the study. Disparities in the prevalence of social barriers emerged by ethnicity: non-Hispanic Blacks reported the greatest number of social barriers, followed by Hispanic patients. Prevalent social barriers included financial strains (38.4%), such as food insecurity, medical care delays (~30%), and low educational attainment (26.8%). Social barriers associated with poor IBD outcomes included low educational attainment, poor health literacy, and financial insecurity. High SBS was associated with greater depressive symptoms [odds ratio (OR) 1.94, 95% confidence interval (CI) 1.21-2.9, p = 0.001] and lower reported use of medications. Greater ulcerative colitis (UC) disease activity was observed in patients with greater SBS. No associations were identified between SBS and IBD surgeries, hospitalizations, or disease location. Conclusion: Our study identifies social barriers that may impact IBD care and are disproportionately higher in non-Hispanic Blacks and Hispanics in the United States. Future studies should focus on implementing interventions to reduce these barriers and improve delivery of care.

Burnout: exploring the differences between U.S. and international medical graduates.

BACKGROUND: International medical graduates (IMGs) have less burnout than U. S. medical school graduates (USMGs) during residency training. This study evaluates possible correlates of differences in burnout rates between USMGs and IMGs. METHODS: We surveyed 375 first-year residents at orientation in June/July 2017. We assessed burnout using the Copenhagen Burnout Inventory (CBI) and used validated scales to measure stress, quality of life (QoL), mastery, and spirituality. We collected data on gender, place of graduation, language fluency, and specialty. We compared CBI scores between USMGs and IMGs, performed a multivariate linear regression analysis of relationships between covariates and CBI subscales, and logistic regression analysis for our categorical definition of burnout. RESULTS: Two hundred twenty-two residents responded for a response rate of 59%. Personal, work or patient- related burnout was common among residents, particularly among USMGs. The most common form of burnout was work-related. Forty nine percent of USMGs have work burnout compared to 26% of IMGs (p < 0.01). In multivariate analysis, being an IMG reduced odds of work-related and of total burnout by 50% (OR 0.5 C.I 0.25-0.99). Perceived mastery was associated with reductions in all subscales of burnout (p < 0.05). Stress and low QoL related to personal and work burnout scores (p < 0.01). CONCLUSION: Work-related burnout is more common among USMGs than in IMGs. Although mastery, QoL and stress were correlates of burnout among all residents, these factors did not explain the difference. Future studies should evaluate the role of medical school structure and curriculum on differences in burnout rates between the two groups.

A case of COVID-19 Reinfection and Systematic Review of Patterns of Reinfection.

We present a case of a middle age Hispanic patient with COVID-19 reinfection. We conducted a systematic review of the literature of reinfection cases and found that women represent the majority of the cases and that reinfection usually presents with more severe disease, particularly among healthcare workers.

Preserving the Cellular Tissue Structure of Maize Pith Though Dry Fractionation Processes: A Key Point to Use as Insulating Agro-Materials.

Plant biomass has various compositions and structures at different scales (from the component organs to their constitutive tissues) to support its functional properties. Recovering each part of the plant without damaging its structure poses a challenge to preserving its original properties for differential dedicated end uses, and considerably increases its added value. In this work, an original combination of grinding based on shearing stress and separation based on particle size and density was successfully used to sort rind (65% w/w) and pith (35% w/w) from maize stem internodes. More than 97% of the rind was isolated. The pith alveolar structure was well preserved in coarse particles, making them suitable for insulation bio-based composite materials, a promising alternative to conventional nonbiodegradable insulation panels. Boards produced from the dry fractionated pith exhibited thermal conductivities like those produced from hand dissected pith, with values equal to 0.037 W·mK-1 and 0.039 W·mK-1, respectively. In the finest fraction (particle size <1 mm), the pith vascular bundles (around 300-400 µm in diameter) were dissociated from parenchyma cells and successfully isolated using a cutting-edge electrostatic separator. Their structures, which provide the plant structural support, make them potentially valuable for reinforcement in composite materials.