Dual-Slope Path Loss Model for Integrating Vehicular Sensing Applications in Urban and Suburban Environments.

The development of intelligent transportation systems (ITS), vehicular ad hoc networks (VANETs), and autonomous driving (AD) has progressed rapidly in recent years, driven by artificial intelligence (AI), the internet of things (IoT), and their integration with dedicated short-range communications (DSRC) systems and fifth-generation (5G) networks. This has led to improved mobility conditions in different road propagation environments: urban, suburban, rural, and highway. The use of these communication technologies has enabled drivers and pedestrians to be more aware of the need to improve their behavior and decision making in adverse traffic conditions by sharing information from cameras, radars, and sensors widely deployed in vehicles and road infrastructure. However, wireless data transmission in VANETs is affected by the specific conditions of the propagation environment, weather, terrain, traffic density, and frequency bands used. In this paper, we characterize the path loss based on the extensive measurement campaign carrier out in vehicular environments at 700 MHz and 5.9 GHz under realistic road traffic conditions. From a linear dual-slope path loss propagation model, the results of the path loss exponents and the standard deviations of the shadowing are reported. This study focused on three different environments, i.e., urban with high traffic density (U-HD), urban with moderate/low traffic density (U-LD), and suburban (SU). The results presented here can be easily incorporated into VANET simulators to develop, evaluate, and validate new protocols and system architecture configurations under more realistic propagation conditions.

Path Loss Characterization in an Outdoor Corridor Environment for IoT-5G in a Smart Campus University at 850 MHz and 3.5 GHz Frequency Bands.

The usage scenarios defined in the ITU-M2150-1 recommendation for IMT-2020 systems, including enhanced Mobile Broadband (eMBB), Ultra-reliable Low-latency Communication (URLLC), and massive Machine Type Communication (mMTC), allow the possibility of accessing different services through the set of Radio Interface Technologies (RITs), Long-term Evolution (LTE), and New Radio (NR), which are components of RIT. The potential of the low and medium frequency bands allocated by the Federal Communications Commission (FCC) for the fifth generation of mobile communications (5G) is described. In addition, in the Internet of Things (IoT) applications that will be covered by the case of use of the mMTC are framed. In this sense, a propagation channel measurement campaign was carried out at 850 MHz and 5.9 GHz in a covered corridor environment, located in an open space within the facilities of the Pedagogical and Technological University of Colombia campus. The measurements were carried out in the time domain using a channel sounder based on a Universal Software Radio Peripheral (USRP) to obtain the received signal power levels over a range of separation distances between the transmitter and receiver from 2.00 m to 67.5 m. Then, a link budget was proposed to describe the path loss behavior as a function of these distances to obtain the parameters for the close-in free space reference distance (CI) and the floating intercept (FI) path loss prediction models. These parameters were estimated from the measurements made using the Minimum Mean Square Error (MMSE) approach. The estimated path loss exponent (PLE) values for both the CI and FI path loss models at 850 MHz and 3.5 GHz are in the range of 2.21 to 2.41, respectively. This shows that the multipath effect causes a lack of constructive interference to the received power signal for this type of outdoor corridor scenario. These results can be used in simulation tools to evaluate the path loss behavior and optimize the deployment of device and sensor network infrastructure to enable 5G-IoT connectivity in smart university campus scenarios.

A rationally designed self-immolative linker enhances the synergism between a polymer-rock inhibitor conjugate and neural progenitor cells in the treatment of spinal cord injury.

Rho/ROCK signaling induced after spinal cord injury (SCI) contributes to secondary damage by promoting apoptosis, inflammation, and axon growth inhibition. The specific Rho-kinase inhibitor fasudil can contribute to functional regeneration after SCI, although inherent low stability has hampered its use. To improve the therapeutic potential of fasudil, we now describe a family of rationally-designed bioresponsive polymer-fasudil conjugates based on an understanding of the conditions after SCI, such as low pH, enhanced expression of specific proteases, and a reductive environment. Fasudil conjugated to poly-l-glutamate via a self-immolative redox-sensitive linker (PGA-SS-F) displays optimal release kinetics and, consequently, treatment with PGA-SS-F significantly induces neurite elongation and axon growth in dorsal root ganglia explants, spinal cord organotypic cultures, and neural precursor cells (NPCs). The intrathecal administration of PGA-SS-F after SCI in a rat model prevents early apoptosis and induces the expression of axonal growth- and neuroplasticity-associated markers to a higher extent than the free form of fasudil. Moreover, a combination treatment comprising the acute transplantation of NPCs pre-treated with PGA-SS-F leads to enhanced cell engraftment and reduced cyst formation after SCI. In chronic SCI, combinatory treatment increases the preservation of neuronal fibers. Overall, this synergistic combinatorial strategy may represent a potentially efficient clinical approach to SCI treatment.

Targeting Alzheimer's disease with multimodal polypeptide-based nanoconjugates.

Alzheimer's disease (AD), the most prevalent form of dementia, remains incurable mainly due to our failings in the search for effective pharmacological strategies. Here, we describe the development of targeted multimodal polypeptide-based nanoconjugates as potential AD treatments. Treatment with polypeptide nanoconjugates bearing propargylamine moieties and bisdemethoxycurcumin or genistein afforded neuroprotection and displayed neurotrophic effects, as evidenced by an increase in dendritic density of pyramidal neurons in organotypic hippocampal culture. The additional conjugation of the Angiopep-2 targeting moiety enhanced nanoconjugate passage through the blood-brain barrier and modulated brain distribution with nanoconjugate accumulation in neurogenic areas, including the olfactory bulb. Nanoconjugate treatment effectively reduced neurotoxic ß amyloid aggregate levels and rescued impairments to olfactory memory and object recognition in APP/PS1 transgenic AD model mice. Overall, this study provides a description of a targeted multimodal polyglutamate-based nanoconjugate with neuroprotective and neurotrophic potential for AD treatment.

Survival and toxicity outcomes of hematopoietic stem cell transplantation for pediatric patients with Fanconi anemia: a unified multicentric national study from the Spanish Working Group for Bone Marrow Transplantation in Children.

Hematopoietic stem cell transplantation (HSCT) is currently the only curative option for hematological manifestations in patients with Fanconi anemia (FA). We report the outcome of 34 patients with FA inside a collaborative multicenter national study based on recommendations of Spanish Working Group for Bone Marrow Transplantation in Children (GETMON) between 2009 and 2016. Fludarabine-based conditioning regimen was carried out in all patients, with low dose total body irradiation in unrelated transplants. Disease status before HSCT was bone marrow failure (BMF) in 30 patients and myelodysplastic syndrome (MDS) in four. Donors were matched siblings donors (MSD) in 18, matched unrelated donors (MUD) in 15, and one haploidentical donor. All except one patient engrafted. Cumulative incidence of grades II-IV acute graft-versus-host disease (GVHD) was 29% and 11% for chronic GVHD. Median follow-up after HSCT was 6.5 years. Seven patients (21%) died due to transplant-related causes, two (6%) because of MDS relapse, and one (3%) after a squamous cell carcinoma. Overall survival (OS) was 73% at 5 years post-transplant, with no differences between MSD and MUD transplants. OS for patients with BMF was 80% while for MDS was 25%. Our data suggest HSCT can cure hematologic manifestations of most FA patients with BMF.

Polyornithine-based polyplexes to boost effective gene silencing in CNS disorders.

Gene silencing therapies have successfully suppressed the translation of target proteins, a strategy that holds great promise for the treatment of central nervous system (CNS) disorders. Advances in the current knowledge on multimolecular delivery vehicles are concentrated on overcoming the difficulties in delivery of small interfering (si)RNA to target tissues, which include anatomical accessibility, slow diffusion, safety concerns, and the requirement for specific cell uptake within the unique environment of the CNS. The present work addressed these challenges through the implementation of polyornithine derivatives in the construction of polyplexes used as non-viral siRNA delivery vectors. Physicochemical and biological characterization revealed biodegradability and biocompatibility of our polyornithine-based system and the ability to silence gene expression in primary oligodendrocyte progenitor cells (OPCs) effectively. In summary, the well-defined properties and neurological compatibility of this polypeptide-based platform highlight its potential utility in the treatment of CNS disorders.

Improving the quality of care in the molecular era for children and adolescents with medulloblastoma.

PURPOSE: Elevated mortality and morbidity rates persist in pediatric patients with medulloblastoma. We present a clinical audit of a real-world cohort of patients in search for pragmatic measures to improve their management and outcome. METHODS/PATIENTS: All pediatric patients with medulloblastoma treated between 2003 and 2016 at a Spanish reference center were reviewed. In the absence of internationally accepted quality indicators (QIs) for pediatric CNS tumors, diagnostic, therapeutic, survival, and time QIs were defined and assessed. RESULTS: Fifty-eight patients were included, 24% were younger children (< 3 years), 36% high risk (anaplastic, metastasis, or surgical residue > 1.5 cm2), and 40% standard risk. Five-year OS was 59.2% (95% CI 47-75); 5-year PFS 36.4% (95% CI 25-53). Five main areas of quality assurance were identified: diagnosis, global strategy, frontline treatment modalities, outcomes, and long-term and end-of-life care. A set of 34 QIs was developed and applied. Lack of central pathology review, delay in the incorporation of novel molecular markers, and absence of a neurocognitive and quality-of-life evaluation program were some of the audit findings. CONCLUSIONS: This real-world research study resulted in the development of a pragmatic set of QIs, aimed to improve clinical audits and quality of care given to children and adolescents with medulloblastoma. We hope that our findings will serve as a reference to further develop a quality assurance system with specific QIs for pediatric CNS tumors in the future and that this will ultimately improve the survival and quality of life of these patients.

Detección y seguimiento de desnutrición en ancianos no institucionalizados por el farmacéutico comunitario en las Islas Baleares / Detection and monitoring of malnutrition among non-institutionalized elderly people, by community pharmacists in the Balearic Islands

Introducción: La desnutrición es un factor de morbi-mortalidad que frecuentemente pasa desapercibido. La detección precoz y un tratamiento adecuado pueden mejorar el pronóstico. En este sentido el farmacéutico comunitario puede ser un agente sanitario útil. Objetivos: Comparar el estado nutricional de personas mayores de 65 años no institucionalizadas en Baleares, antes y después de la intervención del farmacéutico comunitario, y estimar la prevalencia y factores de riesgo de desnutrición en la comunidad. Material y método: Se realizó un cribado mediante el cuestionario MNA entre personas mayores de 65 años usuarias de farmacias comunitarias. En caso de resultar desnutrición o riesgo de padecerla, el farmacéutico comunitario realizó una acción de educación nutricional y se emplazó a los pacientes a dos revisiones a los 3 y 6 meses. Resultados: Se obtuvieron 392 encuestas de las cuales resultó una prevalencia de malnutrición de 0,8% y un riesgo de malnutrición de 12,2%. De los pacientes incluidos en seguimiento solo 14 acabaron el programa. No es un resultado representativo estadísticamente, sin embargo se obtuvo una mejora del estado nutricional en el 45% de ellos. Discusión y conclusiones: El farmacéutico comunitario puede contribuir a detección precoz de la desnutrición, la mejora y el seguimiento del estado nutricional de los pacientes. A pesar de que la mejora en el estado nutricional de los pacientes se debió a la intervención del farmacéutico, se necesitan más estudios para confirmar el efecto de dicha intervención farmacéutica (AU)

Introduction: Malnutrition is a factor of morbidity and mortality that goes unnoticed. For that reason, an early detection and treatment can improve evolution and prognosis. Pharmacist can be a useful piece in early detection and monitoring of malnutrition Objective: To compare nutritional status of elderly non- institutionalized people over the age of 65 in Balearic Island before and after pharmaceutical intervention and to estimate prevalence and risk factors of malnutrition in that segment of the population. Material and methods: A screening was conducted using the MNA questionnaire, between elderly non-institutionalized people over 65 years that came to the pharmacy. In case of risk of malnutrition or malnutrition, the pharmacist gave patients some nutritional recommendations and monitored them at third and sixth month Results: 392 surveys were collected and it was estimated at 0,8% of malnutrition and a 12,2% of risk of malnutrition. Only 14 patients finished the whole follow-up study and 45% of them improved their nutritional status, but those results were not statistically significant. Discussion and conclusions: Pharmacist can contribute in early detection of malnutrition and can improve and monitor nutritional status of malnourished patients. Even tough, improvement of nutritional status was due to pharmaceutical intervention, more studies are needed to confirm the effect of such intervention (AU)

Prognostic factors and outcomes for pediatric patients receiving an haploidentical relative allogeneic transplant using CD3/CD19-depleted grafts.

Haploidentical hematopoietic stem cell transplantation using T-cell-depleted grafts is a valid option for pediatric patients with hematological malignancies in need of an allogeneic transplantation and lacking an HLA-identical donor. Seventy-five transplantations were performed in 70 patients. Thirty-eight patients had ALL, 32 had AML, 3 had advanced myelodysplastic syndromes and 2 juvenile myelomonocytic leukemia; 19 were in first CR, 30 in second CR, 12 in greater than second CR and 14 were considered to be in refractory disease at time of transplantation. Four patients developed graft failure. Among engrafted patients, the median time to neutrophil and platelet recovery was 13 (range 8-20) and 10 days (range 8-70), respectively. In 64 (85%) cases, ⩾1 infections were diagnosed after transplant. The probability of nonrelapse mortality by day +100 after transplantation was 10±4%. With a median follow-up of 22 months, the probability of relapse was 32±6% and disease-free survival was 52±6%. Haploidentical transplantation using CD3/CD19 depletion is associated with encouraging results especially in patients in early phase of disease. Killer-cell Ig-like receptor B haplotype donors confer a rapid natural killer cells expansion early after transplantation, resulting in lower probability of relapse and suggesting a GvL effect apart from graft-versus-host reactions. Donor infusion of high numbers of CD34+ cells is recommended in order to improve T-cell reconstitution.

Smart branched polymer drug conjugates as nano-sized drug delivery systems.

Polymer-drug conjugates represent excellent nanopharmaceutical candidates, as they offer multiple advantages related to their intrinsic characteristics. Many of the said characteristics are provided by the covalent bonding between the drug and the polymer. However, their clinical development has been slow and only one polymer-drug conjugate has reached the market, thus there remains an urgent need for the development of new and smart polymeric systems. Desirable characteristics of these new systems include higher molecular weight and degree of homogeneity, predictable conformations in solution, multivalency, and increased drug loading capacity, amongst others. With these aims in mind, branched polymers are ideal candidates due to their unique rheological, mechanical, and biomedical properties derived from their structure, inaccessible for linear polymers. Within this review, the synthetic strategies developed and the main efforts towards branched polymer implementation as carriers for polymer-drug conjugates will be addressed.

Hiperfosforemia e hipolcacemia grave tras la administración de un enema de fosfatosódico / Severe hyperphosphoremia and hypocalcemia after the administration of a hypertonic sodium phosphate enema

No disponible

Exome sequencing reveals novel and recurrent mutations with clinical impact in blastic plasmacytoid dendritic cell neoplasm.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a very rare disease that currently lacks genomic and genetic biomarkers to assist in its clinical management. We performed whole-exome sequencing (WES) of three BPDCN cases. Based on these data, we designed a resequencing approach to identify mutations in 38 selected genes in 25 BPDCN samples. WES revealed 37-99 deleterious gene mutations per exome with no common affected genes between patients, but with clear overlap in terms of molecular and disease pathways (hematological and dermatological disease). We identified for the first time deleterious mutations in IKZF3, HOXB9, UBE2G2 and ZEB2 in human leukemia. Target sequencing identified 29 recurring genes, ranging in prevalence from 36% for previously known genes, such as TET2, to 12-16% for newly identified genes, such as IKZF3 or ZEB2. Half of the tumors had mutations affecting either the DNA methylation or chromatin remodeling pathways. The clinical analysis revealed that patients with mutations in DNA methylation pathway had a significantly reduced overall survival (P=0.047). We provide the first mutational profiling of BPDCN. The data support the current WHO classification of the disease as a myeloid disorder and provide a biological rationale for the incorporation of epigenetic therapies for its treatment.

Rituximab en el tratamiento de citopenias autoinmunitarias refractarias a tratamientos convencionales / Role of rituximab in the management of refractory autoimmune cytopenia

Objetivo: Evaluar el papel del rituximab en el tratamiento de citopenias autoinmunitarias refractarias a tratamientos convencionales. Material y métodos: Estudio descriptivo longitudinal constituido por una serie de casos clínicos (n = 7) durante el período comprendido entre 2003 y 2010. Resultados: Se recogen 7 pacientes: 4, trombocitopenia inmune primaria; 2, anemia hemolítica autoinmunitaria, y 1, neutropenia autoinmunitaria. Un paciente había recibido trasplante de progenitores hematopoyéticos. La dosis fue de 375mg/m2/semana. Cuatro pacientes recibieron 4 dosis y 3 pacientes recibieron 2, 6 y 8 dosis cada uno. Cinco de los pacientes (71%) cumplieron criterios de respuesta global (completa en 4 pacientes y parcial en 1). A las 8,5 semanas, respondieron la mitad de los pacientes (rango: 3,5-19,5). La mediana de la duración de la respuesta fue de 35,5 semanas (rango: 12,5-53,5). El 100% de los respondedores pudo disminuir su tratamiento previo. Se registraron 2 recaídas. No se registran efectos adversos graves. Conclusiones: El 71% de los pacientes de esta serie responden al tratamiento, disminuyendo el 100% de los respondedores su tratamiento previo. Rituximab es un tratamiento bien tolerado, sin efectos secundarios graves en el período de seguimiento estudiado (AU)

Objectives: This study examined the efficacy of rituximab in children with refractory autoimmune cytopenia. Material and methods: Longitudinal descriptive study comprising a series of clinical cases (n=7) during the period 2003 to 2010. Results: A series 7 patients were included (4 had primary immune thrombocytopenia, 2 autoimmune hemolytic anemia, and 1 autoimmune neutropenia). One patient had received stem cell transplantation. Rituximab was administered intravenously to all patients at a dose of 375mg/mg2 weekly. Four patients received 4 doses. Three patients received 2, 6, and 8 doses, respectively. Overall, 5 patients responded (4 complete responses plus 1 partial response). The median time to achieve complete response was 8.5 weeks (range: 3.5-19.5 weeks). Two patients achieved complete response in the first 3.5 weeks, and the remaining 3 patients between 8.5 and 19.5 weeks. The median time of response was 35.5 weeks (range: 12.5-53.5 weeks). Two patients relapsed. No serious adverse events were recorded. Conclusions: Overall, seventy one percent of patients in this study respond to treatment, 100% of responders decrease their previous treatment. Rituximab was a well tolerated and no related serious side effects were recorded during the study period (AU)

Allogeneic hematopoietic cell transplantation for neuroblastoma: the CIBMTR experience.

Although the role of autologous hematopoietic cell transplantation (auto-HCT) is well established in neuroblastoma (NBL), the role of allogeneic HCT (allo-HCT) is controversial. The Center for International Blood and Marrow Transplant Research conducted a retrospective review of 143 allo-HCT for NBL reported in 1990-2007. Patients were categorized into two different groups: those who had not (Group 1) and had (Group 2) undergone a prior auto-HCT (n=46 and 97, respectively). One-year and five-year OS were 59% and 29% for Group 1 and 50% and 7% for Group 2, respectively. Among donor types, disease-free survival (DFS) and OS were significantly lower for unrelated transplants at 1 and 3 years but not at 5 years post HCT. Patients in CR or very good partial response (VGPR) at transplant had lower relapse rates and better DFS and OS, compared with those not in CR or VGPR. Our analysis indicates that allo-HCT can cure some neuroblastoma patients, with lower relapse rates and improved survival in patients without a history of prior auto-HCT as compared with those patients who had previously undergone auto-HCT. Although the data do not address why either strategy was chosen for patients, allo-HCT after a prior auto-HCT appears to offer minimal benefit. Disease recurrence remains the most common cause of treatment failure.

[Role of rituximab in the management of refractory autoimmune cytopenia]. / Rituximab en el tratamiento de citopenias autoinmunitarias refractarias a tratamientos convencionales.

OBJECTIVES: This study examined the efficacy of rituximab in children with refractory autoimmune cytopenia. MATERIAL AND METHODS: Longitudinal descriptive study comprising a series of clinical cases (n=7) during the period 2003 to 2010. RESULTS: A series 7 patients were included (4 had primary immune thrombocytopenia, 2 autoimmune hemolytic anemia, and 1 autoimmune neutropenia). One patient had received stem cell transplantation. Rituximab was administered intravenously to all patients at a dose of 375 mg/mg(2) weekly. Four patients received 4 doses. Three patients received 2, 6, and 8 doses, respectively. Overall, 5 patients responded (4 complete responses plus 1 partial response). The median time to achieve complete response was 8.5 weeks (range: 3.5-19.5 weeks). Two patients achieved complete response in the first 3.5 weeks, and the remaining 3 patients between 8.5 and 19.5 weeks. The median time of response was 35.5 weeks (range: 12.5-53.5 weeks). Two patients relapsed. No serious adverse events were recorded. CONCLUSIONS: Overall, seventy one percent of patients in this study respond to treatment, 100% of responders decrease their previous treatment. Rituximab was a well tolerated and no related serious side effects were recorded during the study period.

Varicella zoster central nervous system vasculitis after allogeneic hematopoietic stem cell transplant successfully treated with cyclophosphamide.

We report the first case of varicella zoster central nervous system vasculitis, to our knowledge, which responded to intravenous pulses of cyclophosphamide in an immunocompromised child with severe and progressive disease, without sequelae.

Early evaluation of immune reconstitution following allogeneic CD3/CD19-depleted grafts from alternative donors in childhood acute leukemia.

Graft engineering procedures for hematopoietic SCT (HSCT) may improve the chance of success in matched unrelated donor (MUD) and haploidentical donor transplantations. Successful donor immune reconstitution is important to mediate GVL effects in reduced-intensity conditioning (RIC) HSCT. We prospectively investigated early immune reconstitution and clinical outcome in 30 CD3/CD19-depleted MUD (n=15) or HP (n=15) HSCTs for high-risk childhood leukemia using a fludarabine-based RIC without serotherapy. The graft consisted of a mean of 10.5 × 10(6)/kg CD34+, 77 × 10(3)/kg CD3+ and 39 × 10(6)/kg CD56+ cells. After transplantation, 86% of the patients engrafted. In all, 13% of patients had >grade 3 acute GVHD. Natural killer (NK) cell, DC and T-cell recovery achieved normal values within the first 60 days after transplantation. DC recovery was dominated by the DC2(-) subset. NK-cell phenotype was altered and cytotoxicity was lower compared with their donors. EFS was 50±9% (73±11% for those in CR1 and 26±11% for those with advanced disease). Faster DC2(-) recovery was associated with better outcome, especially in the MUD setting. In summary, CD3/CD19-depleted HSCT with fludarabine-based RIC without serotherapy resulted in favorable patient survival, and rapid NK, DC and T-cell recovery.