Determination of Micromovements in Removable Prosthesis during Mastication: A Pilot Study with 3D Electromagnetic Articulography.

Edentulism can generate negative impacts on self-esteem, interpersonal relationships, and oral functions. Removable prostheses are commonly used for tooth replacement, but they may cause discomfort due to micromovements during mastication. Objective and quantifiable methods are needed to evaluate these micromovements. A pilot study was conducted to determine the micromovements in removable prostheses during mastication using a 3D electromagnetic articulography (EMA-3D) system. One elderly participant wearing lower removable prostheses and an upper total well-fitting removable prosthesis was studied. The EMA-3D system was used to record movements in three spatial planes. Peanuts were given as test food, and the participant was instructed to chew normally while recordings were carried out until feeling the need to swallow. Analyses of the upper total prosthesis show micromovements ranging from 0.63 ± 0.11 to 1.02 ± 0.13 mm. During simultaneous analyses of the upper prosthesis and lower partial prosthesis, interference was not observed. This pilot study demonstrated the feasibility of using the EMA-3D system to evaluate micromovements in removable prostheses during mastication. Further research is needed to evaluate a larger sample and assess the clinical implications of these micromovements.

External Validation of SAFE Score to Predict Atrial Fibrillation Diagnosis after Ischemic Stroke: A Retrospective Multicenter Study.

Introduction: The screening for atrial fibrillation (AF) scale (SAFE score) was recently developed to provide a prediction of the diagnosis of AF after an ischemic stroke. It includes 7 items: age ≥ 65 years, bronchopathy, thyroid disease, cortical location of stroke, intracranial large vessel occlusion, NT-ProBNP ≥250 pg/mL, and left atrial enlargement. In the internal validation, a good performance was obtained, with an AUC = 0.88 (95% CI 0.84-0.91) and sensitivity and specificity of 83% and 80%, respectively, for scores ≥ 5. The aim of this study is the external validation of the SAFE score in a multicenter cohort. Methods: A retrospective multicenter study, including consecutive patients with ischemic stroke or transient ischemic attack between 2020 and 2022 with at least 24 hours of cardiac monitoring. Patients with previous AF or AF diagnosed on admission ECG were excluded. Results: Overall, 395 patients were recruited for analysis. The SAFE score obtained an AUC = 0.822 (95% CI 0.778-0.866) with a sensitivity of 87.2%, a specificity of 65.4%, a positive predictive value of 44.1%, and a negative predictive value of 94.3% for a SAFE score ≥ 5, with no significant gender differences. Calibration analysis in the external cohort showed an absence of significant differences between the observed values and those predicted by the model (Hosmer-Lemeshow's test 0.089). Conclusions: The SAFE score showed adequate discriminative ability and calibration, so its external validation is justified. Further validations in other external cohorts or specific subpopulations of stroke patients might be required.

Experience and insights from a prolonged electrocardiographic monitorization with a wearable system after an embolic stroke of unknown source.

BACKGROUND: Embolic cerebrovascular events that remain of unknown etiology after a thorough diagnostic evaluation, are known as Embolic Strokes of Undetermined Source (ESUS). Subclinical atrial fibrillation (AF) represents a significant underlying cause of ESUS. Our aims were to examine the overall diagnostic yield of a prolonged cardiac monitoring wearable system (PCMw) after an ESUS to detect AF and factors associated with it, including the time frame from the ESUS event to PCMw initiation. Additionally, to evaluate the frequency of unexpected arrhythmic events (UAE) and their prognostic implications. METHODS: We retrospectively analyzed 200 ECG recordings (3-leads, 30 days duration) by means of a PCMw in patients with an ESUS to detect AF lasting longer than 30 s, between 2017 and 2021. UAE were defined as arrhythmia events that were not correlated to the main reason of prolonged cardiac monitoring. RESULTS: AF was detected in 21 patients (10.5%). Patients with AF had more left atrial enlargement (OR = 4.22 [1.59-6.85]; p = .01) and atrial arrythmias in the initial 24-h Holter during hospitalization (OR = 5.73 [2.03-16.49]; p = .001). The detection of AF was significatively higher if the PCMw was worn within the first 30 days after the ESUS compared to beyond 30 days (17% vs. 10.3%; p = .002). Fifty three patients (26.5%) had UAE during PCMw. In six of them these findings led to targeted treatment. CONCLUSION: PCMw represents a feasible non-invasive device that could reliably detect subclinical AF episodes after an ESUS. Diagnostic yield was significatively higher when used within the first 30 days after the event, especially in selected patients. UAE were common, but did not impact prognosis.

Renewable Hydrogen Production by Aqueous Phase Reforming of Pure/Refined Crude Glycerol over Ni/Al-Ca Catalysts.

Renewable hydrogen production by aqueous phase reforming (APR) over Ni/Al-Ca catalysts was studied using pure or refined crude glycerol as feedstock. The APR was carried out in a fixed bed reactor at 238 °C, 37 absolute bar for 3 h, using a solution of 5 wt.% of glycerol, obtaining gas and liquid products. The catalysts were prepared by the co-precipitation method, calcined at different temperatures, and characterized before and after their use by several techniques (XRD, ICP-OES, H2-TPR, NH3-TPD, CO2-TPD, FESEM, and N2-physisorption). Increasing the calcination temperature and adding Ca decreased the surface area from 256 to 188 m2/g, and its value after the APR changed depending on the feedstock used. The properties of the acid and basic sites of the catalysts influenced the H2 yield also depending on the feed used. The Ni crystallite was between 6 and 20 nm. In general, the incorporation of Ca into Ni-based catalysts and the increase of the calcination temperature improved H2 production, obtaining 188 mg H2/mol C fed during the APR of refined crude glycerol over Ni/AlCa-675 catalyst, which was calcined at 675 °C. This is a promising result from the point of view of enhancing the economic viability of biodiesel.

Aqueous phase hydrogenolysis of glycerol with in situ generated hydrogen over Ni/Al3Fe1 catalyst: effect of the calcination temperature.

The present work studied the influence of the calcination temperature on the aqueous phase hydrogenolysis of glycerol with in situ generated hydrogen over a Ni/Al3Fe1 catalyst. The Ni/Al3Fe1 catalyst was synthesized by the co-precipitation method at 28 mol% of Ni (Ni/(Ni + Al + Fe)) and a molar ratio of Al/Fe of 3/1. The prepared catalyst was calcined at different temperatures (500-750 °C). The obtained samples were tested for the aqueous phase hydrogenolysis (APH) of glycerol and characterized by several analytical techniques (ICP-OES, H2-TPR, XRD, N2-physisorption, NH3-TPD, STEM, FESEM, and TGA). The catalyst calcined at 625 °C was selected as the best sample due to its high acidity, metal dispersion, and catalytic activity; 1,2-propanediol was the highest carbon selectivity product. In addition, it experienced lower metal leaching than the catalyst calcined at 500 °C.

A longitudinal study of protective factors against substance use in early adolescence. An ecological approach.

BACKGROUND: Adolescent substance use has been widely related to different individual, school, family and community factors. Yet, the number of studies with all these variables together in a model from an ecological perspective is still low, and they rarely used a longitudinal design. The aim of this study was to explore, from an ecological perspective, the prospective impact of different individual, school, family and neighbourhood factors on adolescent substance use. METHODS: This was a longitudinal study with a one-year follow up. There were 881 participants (Mage = 12.57; 48.1% females) at wave 1, of which 686 (Mage = 13.51; 51.8% females) were followed-up at wave 2. Validated questionnaires were used for data collection. RESULTS: Regression analyses showed that higher substance use was predicted by high family socio-economic status cross-sectionally and longitudinally, and it was related to low neighbourhood socio-economic status cross-sectionally only. Participants who disliked school and had a poor academic performance were more likely to use substances, both cross-sectionally and longitudinally. CONCLUSIONS: The inclusion of families in substance use prevention programmes could be a key component in these interventions. Moreover, promotion of a positive school climate could protect adolescents from using substances.

Cisplatin-induced cell death increases the degradation of the MRE11-RAD50-NBS1 complex through the autophagy/lysosomal pathway.

Cisplatin and other platinum-based anticancer agents are among the most widely used chemotherapy drugs in the treatment of different types of cancer. However, it is common to find patients who respond well to treatment at first but later relapse due to the appearance of resistance to cisplatin. Among the mechanisms responsible for this phenomenon is the increase in DNA damage repair. Here, we elucidate the effect of cisplatin on the MRN (MRE11-RAD50-NBS1) DNA damage sensor complex. We found that the tumor suppressor FBXW7 is a key factor in controlling the turnover of the MRN complex by inducing its degradation through lysosomes. Inhibition of lysosomal enzymes allowed the detection of the association of FBXW7-dependent ubiquitylated MRN with LC3 and the autophagy adaptor p62/SQSTM1 and the localization of MRN in lysosomes. Furthermore, cisplatin-induced cell death increased MRN degradation, suggesting that this complex is one of the targets that favor cell death. These findings open the possibility of using the induction of the degradation of the MRN complex after genotoxic damage as a potential therapeutic strategy to eliminate tumor cells.

Neutrophil ß1 adrenoceptor blockade blunts stroke-associated neuroinflammation.

BACKGROUND AND PURPOSE: Reperfusion therapy is the standard of care for ischaemic stroke; however, there is a need to identify new therapeutic targets able to ameliorate cerebral damage. Neutrophil ß1 adrenoceptors (ß1AR) have been linked to neutrophil migration during exacerbated inflammation. Given the central role of neutrophils in cerebral damage during stroke, we hypothesize that ß1AR blockade will improve stroke outcomes. EXPERIMENTAL APPROACH: Rats were subjected to middle cerebral artery occlusion-reperfusion to evaluate the effect on stroke of the selective ß1AR blocker metoprolol (12.5 mg·kg-1 ) when injected i.v. 10 min before reperfusion. KEY RESULTS: Magnetic resonance imaging and histopathology analysis showed that pre-reperfusion i.v. metoprolol reduced infarct size. This effect was accompanied by reduced cytotoxic oedema at 24 h and vasogenic oedema at 7 days. Metoprolol-treated rats showed reduced brain neutrophil infiltration and those which infiltrated displayed a high proportion of anti-inflammatory phenotype (N2, YM1+ ). Additional inflammatory models demonstrated that metoprolol specifically blocked neutrophil migration via ß1AR and excluded a significant effect on the glia compartment. Consistently, metoprolol did not protect the brain in neutrophil-depleted rats upon stroke. In patients suffering an ischaemic stroke, ß1AR blockade by metoprolol reduced circulating neutrophil-platelet co-aggregates. CONCLUSIONS AND IMPLICATIONS: Our findings describe that ß1AR blockade ameliorates cerebral damage by targeting neutrophils, identifying a novel therapeutic target to improve outcomes in patients with stroke. This therapeutic strategy is in the earliest stages of the translational pathway and should be further explored.

CO2 adsorption on pyrolysis char from protein-containing livestock waste: How do proteins affect?

Biogas generation through anaerobic digestion provides an interesting opportunity to valorize some types of animal waste materials whose management is increasingly complicated by legal and environmental restrictions. To successfully expand anaerobic digestion in livestock areas, operational issues such as digestate management must be addressed in an economical and environmentally sustainable way. Biogas upgrading is another necessary stage before intending it to add-value applications. The high concentration of CO2 in biogas results in a reduced caloric value, so the removal of CO2 would be beneficial for most end-users. The current work evaluates the CO2 uptake properties (thermogravimetry study) of low-cost adsorbent materials produced from the animal wastes generated in the livestock area itself, specifically via pyrolysis of poorly biodegradable materials, such as meat and bone meal, and the digestate from manure anaerobic digestion. Therefore, the new element in this study with respect to other studies found in the literature related to biochar-based CO2 adsorption performance is the presence of high content of pyrolyzed proteins in the adsorbent material. In this work, pyrolyzed chars from both meat and bone meal and co-digested manure have been proven to adsorb CO2 reversibly, and also the chars produced from their representative pure proteins (collagen and soybean protein), which were evaluated as model compounds for a better understanding of the individual performance of proteins. The ultra-microporosity developed in the protein chars during pyrolysis seems to be the main explanation for such CO2 uptake capacities, while neither the BET surface area nor N-functionalities on the char surface can properly explain the observed results. Although the CO2 adsorption capacities of these pristine chars (6-41.0 mg CO2/g char) are far away from data of commercially activated carbons (~80 mg CO2/g char), this application opens a new via to integrate and valorize these wastes in the circular economy of the primary sector.

Adolescent Compliance with anti-COVID Measures. Is It Related to Substance Use?

Prevalence rates of compliance with anti-COVID measures have been widely studied, but little is known about this issue in early adolescence. Moreover, the relation between substance use and compliance with anti-COVID regulations is still unexplored. Thus, this study aimed to determine the level of compliance with anti-COVID measures by adolescents and the link between substance use and compliance with anti-COVID regulations. This was a cross-sectional study including 909 participants (M age = 12.57; SD = 0.81). The most complied measure was mask-wearing, followed by avoiding hug/kiss friends and, finally, social distancing. All substance use negatively correlated with compliance with measures. However, strong alcohol and tobacco were the only substances significantly related to less compliance of anti-COVID measures after controlling for covariates. These results provide evidence about the relation between substance use and compliance with anti-COVID measures. Strategies addressed to decrease substance use could be effective to reduce behaviours associated with coronavirus transmission.

A longitudinal study of preadolescent and adolescent substance use: Within-individual patterns and protective factors.

Substance use is one of the main risks for adolescent health. Many research projects have studied longitudinal patterns of use and risk/protective factors, but the number of studies focused on within-individual stability and change is low. The objective of this study was to discover specific longitudinal profiles of drug use and explore the role of social and emotional competencies, and empathy as possible protective factors against substance use. Method: This was a longitudinal study with 879 students (9-17 years at wave 1, 10-18 at wave 2). Substance use, social and emotional competencies, and empathy were measured with a survey. Results: Nine longitudinal profiles of substance use were found in this sample. Multinomial regression analysis found that low responsible decision making, self-management and affective empathy predicted the profiles of ascending user, chronic user and experiencer, respectively. Experiencer was also predicted by a low level of social awareness. Conclusions: The trend to a higher use over time can increase the odds of addiction in future. Some personal variables were found as protective factors against drug use. Thus, school interventions addressed to promote social and emotional competencies, and empathy seem necessary in order to decrease the adolescent drug use.

El consumo de sustancias es uno de los mayores riesgos para la salud de los adolescentes. Numerosas investigaciones han estudiado el patrón longitudinal de consumo y factores de riesgo/protección, pero pocas han estudiado la estabilidad y el cambio a nivel intraindividual. El objetivo de este estudio fue descubrir patrones longitudinales específicos de consumo de drogas y explorar el papel de las competencias sociales y emocionales, y la empatía como posibles factores protectores. Método: Un estudio longitudinal con 879 participantes (9-17 años en tiempo 1; 10-18 en tiempo 2). El consumo de sustancias, las competencias socioemocionales y la empatía se midieron con una encuesta. Resultados: Se encontraron nueve perfiles longitudinales de consumo. Los análisis de regresión encontraron que baja toma de decisiones responsables, autocontrol y empatía afectiva predijeron los perfiles de consumidor ascendente, consumidor crónico y experimentador, respectivamente. Experimentador también fue predicho por bajos niveles de conciencia social. Conclusiones: La tendencia a aumentar el consumo a través del tiempo puede incrementar el riesgo de adicción en el futuro. Algunas variables personales actúan como factores de protección. Por ello, parecen necesarias intervenciones escolares dirigidas a promocionar las competencias sociales y emocionales, y la empatía para disminuir el consumo de sustancias.

Fewer COVID-19-associated strokes and reduced severity during the second COVID-19 wave: The Madrid Stroke Network.

BACKGROUND AND PURPOSE: The experience gained during the first COVID-19 wave could have mitigated the negative impact on stroke care in the following waves. Our aims were to analyze the characteristics and outcomes of patients with stroke admitted during the second COVID-19 wave and to evaluate the differences in the stroke care provision compared with the first wave. METHODS: This retrospective multicenter cohort study included consecutive stroke patients admitted to any of the seven hospitals with stroke units (SUs) and endovascular treatment facilities in the Madrid Health Region. The characteristics of the stroke patients with or without a COVID-19 diagnosis were compared and the organizational changes in stroke care between the first wave (25 February to 25 April 2020) and second wave (21 July to 21 November 2020) were analyzed. RESULTS: A total of 550 and 1191 stroke patients were admitted during the first and second COVID-19 waves, respectively, with an average daily admission rate of nine patients in both waves. During the second wave, there was a decrease in stroke severity (median National Institutes of Health Stroke Scale 5 vs. 6; p = 0.000), in-hospital strokes (3% vs. 8.1%) and in-hospital mortality (9.9% vs. 15.9%). Furthermore, fewer patients experienced concurrent COVID-19 (6.8% vs. 19.1%), and they presented milder COVID-19 and less severe strokes. Fewer hospitals reported a reduction in the number of SU beds or deployment of SU personnel to COVID-19 dedicated wards during the second wave. CONCLUSIONS: During the second COVID-19 wave, fewer stroke patients were diagnosed with COVID-19, and they had less stroke severity and milder COVID-19.

A longitudinal study of preadolescent and adolescent substance use: Within-individual patterns and protective factors / Estudio longitudinal del consumo de sustancias en preadolescentes y adolescentes: patrones intraindividuales y factores protectores

Substance use is one of the main risks for adolescent health. Many research projects have studied longitudinal patterns of use and risk/protective factors, but the number of studies focused on within-individual stability and change is low. The objective of this study was to discover specific longitudinal profiles of drug use and explore the role of social and emotional competencies, and empathy as possible protective factors against substance use. Method: This was a longitudinal study with 879 students (9-17 years at wave 1, 10-18 at wave 2). Substance use, social and emotional competencies, and empathy were measured with a survey. Results: Nine longitudinal profiles of substance use were found in this sample. Multinomial regression analysis found that low responsible decision making, self-management and affective empathy predicted the profiles of ascending user, chronic user and experiencer, respectively. Experiencer was also predicted by a low level of social awareness. Conclusions: The trend to a higher use over time can increase the odds of addiction in future. Some personal variables were found as protective factors against drug use. Thus, school interventions addressed to promote social and emotional competencies, and empathy seem necessary in order to decrease the adolescent drug use. (AU)

El consumo de sustancias es uno de los mayores riesgos para la salud de los adolescentes. Numerosas investigaciones han estudiado el patrón longitudinal de consumo y factores de riesgo/protección, pero pocas han estudiado la estabilidad y el cambio a nivel intraindividual. El objetivo de este estudio fue descubrir patrones longitudinales específicos de consumo de drogas y explorar el papel de las competencias sociales y emocionales, y la empatía como posibles factores protectores. Método: Un estudio longitudinal con 879 participantes (9-17 años en tiempo 1; 10-18 en tiempo 2). El consumo de sustancias, las competencias socioemocionales y la empatía se midieron con una encuesta. Resultados: Se encontraron nueve perfiles longitudinales de consumo. Los análisis de regresión encontraron que baja toma de decisiones responsables, autocontrol y empatía afectiva predijeron los perfiles de consumidor ascendente, consumidor crónico y experimentador, respectivamente. Experimentador también fue predicho por bajos niveles de conciencia social. Conclusiones: La tendencia a aumentar el consumo a través del tiempo puede incrementar el riesgo de adicción en el futuro. Algunas variables personales actúan como factores de protección. Por ello, parecen necesarias intervenciones escolares dirigidas a promocionar las competencias sociales y emocionales, y la empatía para disminuir el consumo de sustancias. (AU)

[High frequency of endoluminal thrombus in patients with ischaemic stroke following COVID-19]. / Alta Frecuencia de Trombo Endoluminal en pacientes con ictus isquémico tras la infección por Coronavirus 2019.

BACKGROUND: Ischaemic stroke may be a major complication of SARS-CoV-2 infection.Studying and characterising the different aetiological subtypes, clinical characteristics, and functional outcomes may be valuable in guiding patient selection for optimal management and treatment. METHODS: Data were collected retrospectively on consecutive patients with COVID-19 who developed acute focal brain ischaemia (between 1 March and 19 April 2020) at a tertiary university hospital in Madrid (Spain). RESULTS: During the study period, 1594 patients were diagnosed with COVID-19. We found 22 patients with ischaemic stroke (1.38%), 6 of whom did not meet the inclusion criteria. The remaining 16 patients were included in the study (15 cases of ischaemic stroke and one case of transient ischaemic attack).Median baseline National Institutes of Health Stroke Scale score was 9 (interquartile range: 16), and mean (standard deviation) age was 73 years (12.8). Twelve patients (75%) were men. Mean time from COVID-19 symptom onset to stroke onset was 13 days. Large vessel occlusion was identified in 12 patients (75%).We detected elevated levels of D-dimer in 87.5% of patients and C-reactive protein in 81.2%. The main aetiology was atherothrombotic stroke (9 patients, 56.3%), with the predominant subtype being endoluminal thrombus (5 patients, 31.2%), involving the internal carotid artery in 4 cases and the aortic arch in one. The mortality rate in our series was 44% (7 of 16 patients). CONCLUSIONS: In patients with COVID-19, the most frequent stroke aetiology was atherothrombosis, with a high proportion of endoluminal thrombus (31.2% of patients). Our clinical and laboratory data support COVID-19-associated coagulopathy as a relevant pathophysiological mechanism for ischaemic stroke in these patients.

Stroke Acute Management and Outcomes During the COVID-19 Outbreak: A Cohort Study From the Madrid Stroke Network.

BACKGROUND AND PURPOSE: The coronavirus disease 2019 (COVID-19) outbreak has added challenges to providing quality acute stroke care due to the reallocation of stroke resources to COVID-19. Case series suggest that patients with COVID-19 have more severe strokes; however, no large series have compared stroke outcomes with contemporary non-COVID-19 patients. Purpose was to analyze the impact of COVID-19 pandemic in stroke care and to evaluate stroke outcomes according to the diagnosis of COVID-19. METHODS: Retrospective multicenter cohort study including consecutive acute stroke patients admitted to 7 stroke centers from February 25 to April 25, 2020 (first 2 months of the COVID-19 outbreak in Madrid). The quality of stroke care was measured by the number of admissions, recanalization treatments, and time metrics. The primary outcome was death or dependence at discharge. RESULTS: A total of 550 acute stroke patients were admitted. A significant reduction in the number of admissions and secondary interhospital transfers was found. COVID-19 was confirmed in 105 (19.1%) patients, and a further 19 patients were managed as suspected COVID-19 (3.5%). No differences were found in the rates of reperfusion therapies in ischemic strokes (45.5% non-COVID-19, 35.7% confirmed COVID-19, and 40% suspected COVID-19; P=0.265). However, the COVID-19 group had longer median door-to-puncture time (110 versus 80 minutes), which was associated with the performance of chest computed tomography. Multivariate analysis confirmed poorer outcomes for confirmed or suspected COVID-19 (adjusted odds ratios, 2.05 [95% CI, 1.12-3.76] and 3.56 [95% CI, 1.15-11.05], respectively). CONCLUSIONS: This study confirms that patients with COVID-19 have more severe strokes and poorer outcomes despite similar acute management. A well-established stroke care network helps to diminish the impact of such an outbreak in stroke care, reducing secondary transfers and allowing maintenance of reperfusion therapies, with a minor impact on door-to-puncture times, which were longer in patients who underwent chest computed tomography.

Highly sampled measurements in a controlled atmosphere at the Biosphere 2 Landscape Evolution Observatory.

Land-atmosphere interactions at different temporal and spatial scales are important for our understanding of the Earth system and its modeling. The Landscape Evolution Observatory (LEO) at Biosphere 2, managed by the University of Arizona, hosts three nearly identical artificial bare-soil hillslopes with dimensions of 11 × 30 m2 (1 m depth) in a controlled and highly monitored environment within three large greenhouses. These facilities provide a unique opportunity to explore these interactions. The dataset presented here is a subset of the measurements in each LEO's hillslopes, from 1 July 2015 to 30 June 2019 every 15 minutes, consisting of temperature, water content and heat flux of the soil (at 5 cm depth) for 12 co-located points; temperature, relative humidity and wind speed above ground at 5 locations and 5 different heights ranging from 0.25 m to 9-10 m; 3D wind at 1 location; the four components of radiation at 2 locations; spatially aggregated precipitation rates, total subsurface discharge, and relative water storage; and the measurements from a weather station outside the greenhouses.

Atención al ictus agudo durante la pandemia por COVID-19. Recomendaciones Plan Ictus Madrid / Acute stroke care during the COVID-19 pandemic. Ictus Madrid Program

INTRODUCCIÓN: La pandemia por COVID-19 ha obligado a una reorganización de los sistemas sanitarios y una saturación excepcional de sus recursos. En este contexto es vital asegurar la atención al ictus agudo y optimizar los procesos asistenciales del código ictus para reducir el riesgo de contagios y racionalizar el uso de recursos hospitalarios. Para ello desde el Grupo multidisciplinar Ictus Madrid proponemos una serie de recomendaciones. MÉTODOS: Revisión bibliográfica no sistemática de las publicaciones disponibles con los términos "stroke" y "covid-19" o "coronavirus" o "SARS-COV-2", así como otras conocidas por los autores. En base a ésta se redacta un documento de recomendaciones que es sometido a consenso por el Grupo multidisciplinar Ictus Madrid y su Comité de Neurología. RESULTADOS: Las recomendaciones se estructuran en cinco líneas fundamentales: (1) Coordinar la actuación para garantizar el acceso la asistencia hospitalaria de los pacientes con ictus, (2) Reconocer a los pacientes con ictus potencialmente infectados por COVID-19, (3) Organización adecuada para garantizar la protección de los profesionales sanitarios frente al riesgo de contagio por COVID-19, (4) la realización de Neuroimagen y otros procedimientos que conlleven contactos de riesgo de infección COVID-19 hay que procurar reducirlos y asegurar la protección, y (5) alta y seguimiento seguros procurando optimizar la ocupación hospitalaria. Resumimos el procedimiento de forma esquemática con el acrónimo CORONA (COordinar, Reconocer, Organizar, Neuroimagen, Alta). CONCLUSIONES: Estas recomendaciones pueden servir de apoyo para la organización del sistema sanitario en la atención al ictus agudo y la optimización de sus recursos, garantizando la protección de sus profesionales

BACKGROUND: The COVID-19 pandemic has forced a reorganization of healthcare systems and an exceptional saturation of their resources. In this context, it is vital to ensure acute stroke care and optimize the care processes of the stroke code to reduce the risk of contagion and rationalize the use of hospital resources. To do this, the Ictus Madrid multidisciplinary group proposes a series of recommendations. METHODS: Non-systematic bibliographic review of the available publications with the terms "stroke" and "covid-19" or "coronavirus" or "SARS-COV-2", as well as other already known for the authors. We provide a document of recommendations as a result of the consensus of the Ictus Madrid multidisciplinary group and its Neurology Committee. RESULTS: Our recommendations are structured on five lines: (1) Coordinate to guarantee the access to hospital care for stroke patients, (2) Recognize potentially COVID-19 infected stroke patients, (3) Organize to ensure the protection of healthcare professionals from COVID-19 infections, (4) Neuroimaging and other procedures potentially associated to risks for COVID-19 infection should be reduced and secured to avoid contagion, and (5) At home as soon as posible and supported follow-up to optimize hospital occupancy. The procedure is shown summarized under the acronym CORONA (Coordinate, Recognize, Organize, Neuroimaging, At home). CONCLUSIONS: These recommendations can support the organization of healthcare services for acute stroke care and the optimization of their resources, guaranteeing the protection of healthcare professionals

Prehospital selection of thrombectomy candidates beyond large vessel occlusion: M-DIRECT scale.

OBJECTIVE: Current prehospital scales used to detect large vessel occlusion reveal very low endovascular thrombectomy (EVT) rates among selected patients. We developed a novel prehospital scale, the Madrid-Direct Referral to Endovascular Center (M-DIRECT), to identify EVT candidates for direct transfer to EVT-capable centers (EVT-Cs). The scale evaluated clinical examination, systolic blood pressure, and age. Since March 2017, patients closer to a stroke unit without EVT capabilities and an M-DIRECT positive score have been transferred to the nearest EVT-C. To test the performance of the scale-based routing protocol, we compared its outcomes with those of a simultaneous cohort of patients directly transferred to an EVT-C. METHODS: In this prospective observational study of consecutive patients with stroke code seen by emergency medical services, we compared diagnoses, treatments, and outcomes of patients who were closer to an EVT-C (mothership cohort) with those transferred according to the M-DIRECT score (M-DIRECT cohort). RESULTS: The M-DIRECT cohort included 327 patients and the mothership cohort 214 patients. In the M-DIRECT cohort, 227 patients were negative and 100 were positive. Twenty-four (10.6%) patients required secondary transfer, leaving 124 (38%) patients from the M-DIRECT cohort admitted to an EVT-C. EVT rates were similar for patients with ischemic stroke in both cohorts (30.9% vs 31.5%). The M-DIRECT scale had 79% sensitivity, 82% specificity, and 53% positive predictive value for EVT. Recanalization and independence rates at 3 months did not differ between the cohorts. CONCLUSIONS: The M-DIRECT scale was highly accurate for EVT, with treatment rates and outcomes similar to those of a mothership paradigm, thereby avoiding EVT-C overload with a low rate of secondary transfers.

Tracing Copper Migration in the Tongling Area through Copper Isotope Values in Soils and Waters.

Copper mining in Tongling has occurred since the Bronze Age, and this area is known as one of the first historic places where copper has been, and is currently, extracted. Multiple studies have demonstrated, through concentrated work on soils and waters, the impact of mining in the area. Here we present copper isotope values of 13 ore samples, three tailing samples, 20 water samples (surface and groundwater), and 94 soil samples (15 different profiles ranging in depth from 0⁻2 m) from proximal to distal (up to 10 km) locations radiating from a tailings dam and tailings pile. Oxidation of the copper sulfide minerals results in isotopically heavier oxidized copper. Thus, copper sourced from sulfide minerals has been used to trace copper in mining and environmental applications. At Tongling, higher copper isotope values (greater than 1 per mil, which are interpreted to be derived from copper sulfide weathering) are found both in waters and the upper portions of soils (5⁻100 cm) within 1 km of the source tailings. At greater than 1 km, the soils do not possess heavier copper isotope values; however, the stream water samples that have low copper concentrations have heavier values up to 6.5 km from the source. The data suggest that copper derived from the mining activities remains relatively proximal in the soils but can be traced in the waters at greater distances.