Patterns of prokaryotic activity along the marine planktonic matter continuum.

Prokaryotic abundance and activity are commonly assessed by dividing them into two size-fractions: free-living and attached to particles. Nevertheless, organic matter, essential for the growth of heterotrophic prokaryotes, is present in the environment in a continuum of sizes, from purely dissolved to large particles. Therefore, defining the activity of the prokaryotic community would be more accurate by considering all the distinct size fractions. To achieve this, we measured prokaryotic abundance (PA), heterotrophic prokaryotic activity (as leucine incorporation) and extracellular enzyme activities at a coastal site in the NW Mediterranean Sea. We conducted measurements in both bulk seawater and size fractionated samples sequentially passing through 5 different filter types: 0.2-0.8-3-5-10 µm pore size. Our results indicate that the fraction <0.8 µm contained the highest percentage of cells (91.6 ± 1.1 %) and leucine incorporation rates (72.2 ± 3.5 %). Most of the extracellular enzyme activity appeared in the dissolved fraction (<0.2 µm; 19.8-79.4 %), yet the specific activity of the enzymes (per cell activity) was 100-1000 times higher in the particulate (>0.8 µm) than in the free-living (0.2-0.8 µm) fraction. The size fraction with highest specific activities for leucine incorporation and most of the enzyme activities (ß-glucosidase, esterase, Leu-aminopeptidase and alkaline phosphatase) was the 5-10 µm fraction. In contrast, the higher specific chitobiase activity in the >10 µm fraction, suggests that the prokaryotic community colonizing large particles might be more specialized in the hydrolysis of organic matter of zooplanktonic origin than the community colonizing smaller particles.

Transcriptional dynamics orchestrating the development and integration of neurons born in the adult hippocampus.

The adult hippocampus generates new granule cells (aGCs) that exhibit distinct functional capabilities along development, conveying a unique form of plasticity to the preexisting circuits. While early differentiation of adult radial glia-like neural stem cells (RGL) has been studied extensively, the molecular mechanisms guiding the maturation of postmitotic neurons remain unknown. Here, we used a precise birthdating strategy to follow newborn aGCs along differentiation using single-nuclei RNA sequencing (snRNA-seq). Transcriptional profiling revealed a continuous trajectory from RGLs to mature aGCs, with multiple sequential immature stages bearing increasing levels of effector genes supporting growth, excitability and synaptogenesis. Remarkably, four discrete cellular states were defined by the expression of distinct sets of transcription factors (TFs): quiescent neural stem cells, proliferative progenitors, postmitotic immature aGCs, and mature aGCs. The transition from immature to mature aCGs involved a transcriptional switch that shutdown molecular cascades promoting cell growth, such as the SoxC family of TFs, to activate programs controlling neuronal homeostasis. Indeed, aGCs overexpressing Sox4 or Sox11 remained stalled at the immature state. Our results unveil precise molecular mechanisms driving adult neural stem cells through the pathway of neuronal differentiation.

The impact of COVID-19 pandemic on the incidence of acute gastroenteritis outbreaks in Catalonia (Spain).

We carried out a retrospective study of acute gastroenteritis (AGE) outbreaks reported between 1 January 2015 and 31 December 2021 in Catalonia (Spain) to compare the incidence from 2015 to 2019 with that observed from 2020 to 2021. We observed a higher incidence rate of outbreaks during the prepandemic period (16.89 outbreaks/1,000,000 person-years) than during the pandemic period (6.96 outbreaks/1,000,000 person-years) (rate ratio (RR) 0.41; 95% confidence interval (CI) 0.34 to 0.51). According to the aetiology of the outbreak, those of viral aetiology decreased from 7.82 to 3.38 outbreaks/1,000,000 person-years (RR 2.31; 95% CI 1.72 to 3.12), and those of bacterial aetiology decreased from 5.01 to 2.78 outbreaks/1,000,000 person-years (RR 1.80; 95% CI 1.29 to 2.52). There was a great reduction in AGE outbreaks in Catalonia. This reduction may have been due to the effect of the nonpharmaceutical measures applied to reduce the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the collapse of the healthcare system and epidemiological surveillance services may also have had a strong influence.

Revisión del intervalo de referencia del recuento plaquetario: ¿son adecuados los valores que estamos utilizando? / Review of the platelet count reference range: are the values we are using appropriate?

Los intervalos de referencia (IR) dependen de la población y de las características metrológicas del procedimiento de medida utilizado. A pesar de las recomendaciones internacionales, son pocos los laboratorios que establecen sus propios IR para cada magnitud por la dificultad para conseguir voluntarios de referencia y el elevado costo económico asociado. La International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) acepta la adopción de IR bibliográficos o su cálculo por métodos indirectos dado su bajo costo y fácil obtención. Existen varias fuentes confiables de IR bibliográficos para el hemograma. No obstante, para el recuento plaquetario, es una práctica común de los laboratorios emplear el rango de valores de 150-450.109 /L independiente de la metodología utilizada y grupo etario. El objetivo de este trabajo fue revisar los IR bibliográficos disponibles para el recuento plaquetario y estimarlo empleando el método indirecto de Hoffmann a partir de nuestra población. Los métodos indirectos se basan en aplicar criterios de exclusión y cálculos matemáticos sobre los resultados de una base de datos de laboratorio. Nuestros IR para el recuento plaquetario se comparan con los bibliográficos, que han sido establecidos por técnicas de muestreo directo. Por este motivo y dado que no existen estudios poblacionales que lo avalen, sería apropiado reemplazar el rango de 150-450.109 / L. Estos límites podrían seguir empleándose como puntos de corte o niveles de decisión médica para definir, según la clínica y otros resultados de laboratorio, los pacientes que ameritan un seguimiento posterior (AU)

Reference ranges (RR) depend on the population and the metrological characteristics of the measurement procedure used. Despite international recommendations, few laboratories establish their own RRs for each magnitude because of the difficulty in obtaining reference volunteers and the associated high economic cost. The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) accepts the use of literaturebased RRs or RRs calculated by indirect methods because of their low cost and easy collection. There are several reliable sources of literature-based RRs for the Cell Blood Count. However, for platelet count, it is common laboratory practice to use the range of 150-450,109 /L regardless of the methodology used and age group. The aim of this study was to review the available literature regarding RRs for platelet count and to establish it using the indirect Hoffmann method in our population. Indirect methods are based on applying exclusion criteria and mathematical calculations on the results of a laboratory database. Our RRs for platelet counts are compared with those in the literature, which have been established by direct sampling techniques. Therefore, and given that there are no population studies to support these findings, it would be appropriate to replace the 150-450,109 /L range. These limits may continue to be used as cut-off points or medical decision levels to define, according to clinical manifestations and other laboratory results, patients who warrant further follow-up (AU)

Prevalence, risk factors and evolution of diabetes mellitus after treatment in primary aldosteronism. Results from the SPAIN-ALDO registry.

PURPOSE: To evaluate the prevalence, risk factors and evolution of diabetes mellitus (DM) after targeted treatment in patients with primary aldosteronism (PA). METHODS: A retrospective multicenter study of PA patients in follow-up at 27 Spanish tertiary hospitals (SPAIN-ALDO Register). RESULTS: Overall, 646 patients with PA were included. At diagnosis, 21.2% (n = 137) had DM and 67% of them had HbA1c levels < 7%. In multivariate analysis, family history of DM (OR 4.00 [1.68-9.53]), the coexistence of dyslipidemia (OR 3.57 [1.51-8.43]) and advanced age (OR 1.04 per year of increase [1.00-1.09]) were identified as independent predictive factors of DM. Diabetic patients were on beta blockers (46.7% (n = 64) vs. 27.5% (n = 140), P < 0.001) and diuretics (51.1% (n = 70) vs. 33.2% (n = 169), p < 0.001) more frequently than non-diabetics. After a median follow-up of 22 months [IQR 7.5-63.0], 6.9% of patients developed DM, with no difference between those undergoing adrenalectomy and those treated medically (HR 1.07 [0.49-2.36], p = 0.866). There was also no significant difference in the evolution of glycemic control between DM patients who underwent surgery and those medically treated (p > 0.05). CONCLUSION: DM affects about one quarter of patients with PA and the risk factors for its development are common to those of the general population. Medical and surgical treatment provides similar benefit in glycemic control in patients with PA and DM.

Drug-related problems in patients admitted for SARS-CoV-2 infection during the COVID-19 pandemic.

Introduction: Drug-related problems (DRP) are events or circumstances in which drug therapy does or could interfere with desired health outcomes. In December 2019, a new coronavirus, SARS-CoV-2, appeared. Little knowledge about this type of infection resulted in the administration of various drugs with limited use in other pathologies. Evidence about DRP in patients with COVID-19 is lacking. Objective: The aim of the present study is to describe identified cases of DRP and those drugs involved in the first wave of patients with COVID-19, and evaluate associated risk factors. Material and methods: Observational, retrospective study performed in a tertiary university hospital between 14th March 2020 and 31 May 2020 (corresponding to the first COVID-19 wave). We recruited patients admitted during the study period. Exclusion criteria included age < 18 years; admission to critically ill units; and care received either in the emergency room, at-home hospitalization or a healthcare center. Results: A total of 817 patients were included. The mean age was 62.5 years (SD 16.4) (range 18-97), and 453 (55.4%) were male. A total of 516 DRP were detected. Among the patients, 271 (33.2%) presented at least one DRP. The mean DRP per patient with an identified case was 1.9. The prevailing DRPs among those observed were: incorrect dosage (over or underdosage) in 145 patients (28.2%); wrong drug combination in 131 (25.5%); prescriptions not in adherence to the then COVID-19 treatment protocol in 73 (14.1%); prescription errors due to the wrong use of the computerized physician order entry in 47 (9.2%); and incorrect dosage due to renal function in 36 (7%). The logistic regression analysis showed that patients who received only prescriptions of antibacterials for systemic use (J01 ATC group) faced a higher likelihood of experiencing a DRP (OR 2.408 (1.071-5.411), p = 0.033). Conclusion: We identified several factors associated with an increased risk of DRPs, similar to those reported in other pre-pandemic studies, including a prolonged length of stay, higher number of prescribed drugs and antimicrobial administration. The relevance of pharmacists and tools like pharmacy warning systems can help prevent, identify and resolve DRP efficiently.

Determination of essential biomarkers in lung cancer: a real-world data study in Spain with demographic, clinical, epidemiological and pathological characteristics.

BACKGROUND: The survival of patients with lung cancer has substantially increased in the last decade by about 15%. This increase is, basically, due to targeted therapies available for advanced stages and the emergence of immunotherapy itself. This work aims to study the situation of biomarker testing in Spain. PATIENTS AND METHODS: The Thoracic Tumours Registry (TTR) is an observational, prospective, registry-based study that included patients diagnosed with lung cancer and other thoracic tumours, from September 2016 to 2020. This TTR study was sponsored by the Spanish Lung Cancer Group (GECP) Foundation, an independent, scientific, multidisciplinary oncology society that coordinates more than 550 experts and 182 hospitals across the Spanish territory. RESULTS: Nine thousand two hundred thirty-nine patients diagnosed with stage IV non-small cell lung cancer (NSCLC) between 2106 and 2020 were analysed. 7,467 (80.8%) were non-squamous and 1,772 (19.2%) were squamous. Tumour marker testing was performed in 85.0% of patients with non-squamous tumours vs 56.3% in those with squamous tumours (p-value < 0.001). The global testing of EGFR, ALK, and ROS1 was 78.9, 64.7, 35.6% respectively, in non-squamous histology. PDL1 was determined globally in the same period (46.9%), although if we focus on the last 3 years it exceeds 85%. There has been a significant increase in the last few years of all determinations and there are even close to 10% of molecular determinations that do not yet have targeted drug approval but will have it in the near future. 4,115 cases had a positive result (44.5%) for either EGFR, ALK, KRAS, BRAF, ROS1, or high PDL1. CONCLUSIONS: Despite the lack of a national project and standard protocol in Spain that regulates the determination of biomarkers, the situation is similar to other European countries. Given the growing number of different determinations and their high positivity, national strategies are urgently needed to implement next-generation sequencing (NGS) in an integrated and cost-effective way in lung cancer.

Charge and Spin Order Dichotomy in NdNiO_{2} Driven by the Capping Layer.

Superconductivity in infinite-layer nickelates holds exciting analogies with that of cuprates, with similar structures and 3d-electron count. Using resonant inelastic x-ray scattering, we studied electronic and magnetic excitations and charge density correlations in Nd_{1-x}Sr_{x}NiO_{2} thin films with and without an SrTiO_{3} capping layer. We observe dispersing magnons only in the capped samples, progressively dampened at higher doping. We detect an elastic resonant scattering peak in the uncapped x=0 compound at wave vector (∼⅓,0), remindful of the charge order signal in hole doped cuprates. The peak weakens at x=0.05 and disappears in the superconducting x=0.20 film. The role of the capping on the electronic reconstruction far from the interface remains to be understood.

Impact of smoking status on the relative efficacy of the EGFR TKI/angiogenesis inhibitor combination therapy in advanced NSCLC-a systematic review and meta-analysis.

BACKGROUND: The ETOP 10-16 BOOSTER trial failed to demonstrate a progression-free survival (PFS) benefit for adding bevacizumab to osimertinib in second line. An exploratory subgroup analysis, however, suggested a PFS benefit of the combination in patients with a smoking history and prompted us to do this study. METHODS: A systematic review and meta-analysis to evaluate the differential effect of smoking status on the benefit of adding an angiogenesis inhibitor to epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor therapy was carried out. All relevant randomized controlled trials appearing in main oncology congresses or in PubMed as of 1 November 2021 were used according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Primarily PFS according to smoking status, and secondarily overall survival (OS) were of interest. Pooled and interaction hazard ratios (HRs) were estimated by fixed or random effects models, depending on the detected degree of heterogeneity. Bias was assessed using the revised Cochrane tool for randomized controlled trials (RoB 2). RESULTS: Information by smoking was available for 1291 patients for PFS (seven studies) and 678 patients for OS (four studies). The risk of bias was low for all studies. Combination treatment significantly prolonged PFS for smokers [n = 502, HR = 0.55, 95% confidence interval (CI): 0.44-0.69] but not for nonsmokers (n = 789, HR = 0.92, 95% CI: 0.66-1.27; treatment-by-smoking interaction P = 0.02). Similarly, a significant OS benefit was found for smokers (n = 271, HR = 0.66, 95% CI: 0.47-0.93) but not for nonsmokers (n = 407, HR = 1.07, 95% CI: 0.82-1.42; treatment-by-smoking interaction P = 0.03). CONCLUSION: In advanced EGFR-non-small-cell lung cancer patients, the addition of an angiogenesis inhibitor to EGFR-tyrosine kinase inhibitor therapy provides a statistically significant PFS and OS benefit in smokers, but not in non-smokers. The biological basis for this observation should be pursued and could determine whether this might be due to a specific co-mutational pattern produced by tobacco exposure.

Particulate and dissolved fluorescent organic matter fractionation and composition: Abiotic and ecological controls in the Southern Ocean.

Phytoplankton-derived organic matter sustains heterotrophic marine life in regions away from terrestrial inputs such as the Southern Ocean. Fluorescence spectroscopy has long been used to characterize the fluorescent organic matter (FOM) pool. However, most studies focus only in the dissolved FOM fraction (FDOM) disregarding the contribution of particles. In order to assess the dynamics and drivers of the dissolved and particulate fractions of FOM, we used a Lagrangian approach to follow the time evolution of phytoplankton proliferations at four different sites in the Southern Ocean and compared the FOM in filtered and unfiltered seawater aliquots. We found that filtration had little effects on FOM visible spectrum fluorescence intensities, implying that most of this signal was due to dissolved fluorophores. On the other hand, protein-like fluorescence was strongly supressed by filtration, with fluorescence of particles accounting for up to 90 % of the total protein-like FOM. Photobleaching was identified as the main driver of visible FDOM composition, which was better described by indices of phytoplankton photoacclimation than by measurements of the incident solar radiation dose. In contrast, protein-like FOM intensity and fractionation were primarily related to abundance, composition and physiological state of phytoplankton proliferations. The chlorophyll a concentration from non-diatom phytoplankton explained 91 % of the particulate protein-like FOM variability. The proportion of protein-like fluorescence found in the dissolved phase was predicted by the combination of potential viral and grazing pressures, which accounted for 51 and 29 % of its variability, respectively. Our results show that comparing FOM measurements from filtered and unfiltered seawater provides relevant information on the taxonomic composition and cell integrity of phytoplankton communities. A better understanding of the commonly overlooked FOM fractionation process is essential for the implementation of in situ fluorescence sensors and will also help us better understand the processes that govern OM cycling in marine systems.

Explorando la nutrición en la farmacia comunitaria con nuevas herramientas. Ciclo de podcasts / Exploring nutrition in community pharmacy with new tools. Podcast series

JUSTIFICACIÓN: la farmacia comunitaria es lugar idóneo para tratar temas de salud relacionados con la nutrición. Muchas patologías y sus tratamientos precisan de consejo o intervención en el plano nutricional. La situación de pandemia actual ha obligado a buscar nuevas estrategias de formación y los podcasts han irrumpido como alternativa muy interesante.OBJETIVOS: formar a los farmacéuticos comunitarios en el área de Nutrición en farmacia comunitaria, mediante un ciclo de podcast. Potenciar la utilización de tecnologías de la información y comunicación (TIC) en el colectivo farmacéutico. Analizar y valorar el impacto de la herramienta de formación diseñada.MATERIAL Y MÉTODOS: los contenidos fueron desarrollados por farmacéuticos comunitarios, pertenecientes al grupo de Nutrición y Digestivo de SEFAC, con experiencia en los temas tratados y sometidos a una revisión por pares para garantizar la calidad. Posteriormente, los encargados de la creación de contenidos procedieron a su grabación con la participación de un periodista y finalmente fueron editados para su difusión a través de Ivoox, Spotify y Apple Podcasts.RESULTADOS: se grabaron un total de 11 podcasts con una duración media de 18 minutos sobre los títulos que se detallan a continuación relacionados con la nutrición y su aplicación en la farmacia comunitaria: La Vitamina D Proteína y salud muscular Desnutrición Ejercicio físico y salud. Prevenir la deshidratación. Interacción fármacos- nutrientes. Prevenir y tratar las úlceras de presión El rincón del mayor en la farmacia comunitaria. Desnutrición en procesos oncológicos Diabetes y nutrición ¿Es posible un servicio de nutrición en la farmacia comunitaria? Se procedió a su emisión en las plataformas mencionadas de febrero a diciembre de 2021 a razón de uno por mes. La media de escuchas de la colección fue a fecha 21 de febrero de 922. (AU)

Evaluación de los factores de riesgo/prevención asociados al deterioro cognitivo en pacientes que cursan con dolor crónico. Estudio piloto / Assessment of risk/prevention factors associated with cognitive impairment in patients with chronic pain. Pilot study

JUSTIFICACIÓN: las enfermedades crónicas sistémicas son causadas por una alteración del sistema inmunitario, siendo en ocasiones incapacitantes para el paciente, derivando en un estado depresivo y pudiendo asociarse con el estado prodrómico del deterioro cognitivo (DC), en el cual, el paciente presenta una serie de incapacidades y olvidos diferentes a los que surgen por la propia edad. En el presente trabajo, tenemos tres grupos a estudio; dolor crónico e inflamación (Artritis Reumatoide, AR), dolor crónico sin inflamación (Fibromialgia, FM) y controles sin dolor ni inflamación.OBJETIVOS: 1.Detectar posible deterioro cognitivo en la población seleccionada.2.Evaluar los factores de riesgo/prevención de DC.3.Estudiar la medicación utilizada como factor de riesgo de DC.4.Analizar el posible vínculo entre depresión y demencia.METODOLOGÍA: este proyecto fue aprobado por el comité ético con el código CEI21/023. Todos los pacientes firmaron el consentimiento informado como establece el RGPD y la Ley Orgánica 3/2018. Los criterios de inclusión fueron: pacientes de artritis reumatoide o fibromialgia mayores de 50 años y controles sanos de edades similares usuarios de farmacia comunitaria.RESULTADOS/DISCUSIÓN: el 21 % de los pacientes dieron positivo en los test de cribado de deterioro cognitivo. Los fármacos más prescritos fueron los antidepresivos y los ansiolíticos, ambos grupos atraviesan la BHE produciendo efectos anticolinérgicos como reacciones adversas. El dolor crónico que sufren puede desencadenar en un estado depresivo (45 % de depresión), lo que potencia aún más los factores de riesgo de DC. La pérdida de relaciones sociales y las alteraciones de sueño, factores de riesgo de DC, se relacionan con el estado depresivo, lo que nos hace sospechar de la depresión y/o su tratamiento farmacológico como estado prodrómico al DC. (AU)

Detección de deterioro cognitivo en pacientes con enfermedades inflamatorias inmunomediadas (IMID). Estudio nutricional / Detection of cognitive impairment in patients with immune-mediated inflammatory diseases (IMID). Nutritional study

JUSTIFICACIÓN: la prevalencia mundial de demencia en 2015 fue de 47 millones. Se estima que para 2030 aumente a 75 millones. Estudios recientes estudian la posible implicación de las enfermedades inflamatorias como factor de riesgo para un desarrollo temprano del deterioro cognitivo. Factores como una mala nutrición (exceso y déficit), pueden facilitar el desarrollo y agravamiento de la enfermedad, mientras que seguir una dieta saludable puede actuar como factor protector. Además, el déficit de vitamina D se ha relacionado con un empeoramiento de las funciones neuronales. Por otra parte, las enfermedades con componente inflamatorio han demostrado poseer una estrecha relación con el deterioro cognitivo.OBJETIVOS: desarrollar una terapia nutricional antiinflamatoria y poner en práctica la terapia nutricional desarrollada en pacientes con artritis reumatoide o fibromialgia para comprobar la eficacia y la adherencia durante 4 meses.MATERIAL Y MÉTODOS: se realizó una búsqueda bibliografía acerca de los alimentos tanto proinflamatorios como antiinflamatorios. Se diseñó una terapia nutricional basada en la dieta mediterránea con un aumento del consumo de alimentos antiinflamatorios y una disminución de los proinflamatorios. Se seleccionaron 80 pacientes de más de 50 años divididos en tres grupos y se cribaron mediante tests de deterioro cognitivo, test nutricionales y test de depresión para la evaluación nutricional. Se calculó la prevalencia de desnutrición, la ADM y su relación con la desnutrición y el deterioro cognitivo. Este estudio fue aprobado por el comité de ética de la universidad UCH-CEU con CEI20/095. Se observó una baja adherencia a la dieta mediterránea en los pacientes con fibromialgia (52%) y queja de memoria(43%). De los pacientes con fibromialgia, un 45% presentó riesgo de desnutrición, mientras que de queja de memoria un 43% dio positivo en los tests compatibles con DC. (AU)

The additional value of weight-bearing and gravity stress ankle radiographs in determining stability of isolated type B ankle fractures.

GOAL: The aim of this study is to investigate whether weight-bearing and gravity stress radiographs have additional value in predicting concomitant deep deltoid ligamentous (DDL) injury in case of isolated Weber type B fibular fractures. This may help to make the clinically relevant distinction between unstable fractures and fractures that can be treated conservatively. METHODS: In this prospective cohort study, 90 patients with an isolated type B ankle fracture, without a medial or posterior fracture, and a medial clear space (MCS) < 6 mm on the regular mortise (RM) view were included. In all patients, an additional gravity stress (GS) view and an MRI scan were performed. Furthermore, in 51 patients, an additional weight-bearing (WB) radiograph was performed. The MCS and superior clear space (SCS) measurements of these radiographs were compared with MRI findings to measure sensitivity and specificity in excluding deep deltoid ligament (DDL) rupture. RESULTS: The mean MCS on the RM view was 3.32 mm (1.73-5.93) compared to 4.75 mm (2.33-10.40) on the GS view and 3.18 mm (1.93-6.9) on the WB radiograph. MRI showed a high-grade or complete deltoid ligament tear in 25 (28%) patients. Using an MCS cut-off value of ≥ SCS + 2 mm, the RM view showed 0% sensitivity and 97% specificity in diagnosing a DDL rupture. Both the GS view (with MCS ≥ SCS + 3 mm as cut-off value) and the WB radiograph (with cut-off value MCS ≥ SCS + 2 mm) showed 6% sensitivity and 100% specificity. CONCLUSION: The gravity stress and weight-bearing radiograph can accurately exclude DDL injury. They might have extra value in addition to the conventional mortise view in assessing the stability of isolated type B ankle fractures. This helps in deciding whether patients should be selected for operative or safe conservative treatment.

Perceptions from nurses, surgeons, and anesthetists about the use and benefits of the surgical checklist in a teaching hospital.

OBJECTIVE: To assess attitudes and perceptions from nursing staff, surgeons and anesthetists about compliance, utility, and impact on patient's safety of the surgical checklist in a teaching hospital. We also aimed to identify improvement opportunities for strengthening the usefulness of the checklist in the operating theater. METHODS: We carried out a questionnaire-based an observational cross-sectional study. A questionnaire was distributed to operating room staff, including nursing staff, surgeons, and anesthetists. In addition to the information about surgical checklist, We also collected information regarding years of experience in the operating theater. Fisher's exact was used to compare proportions in each statement. Group discussion meetings with key professionals were held to jointly assess the results, propose improvement actions, and evaluate their feasibility. RESULTS: The overall response rate was 36.2% (131/362). Nursing staff was perceived as the most supportive group in the use of surgical checklist. A 64.3% of surgeons considered that using the checklist prevented adverse events vs 84.2% and 85.7% among anesthetists and nurses, respectively; p=0.028. Junior staff showed a supportive attitude toward the use of surgical checklist, considering it as a tool that gives them confidence. We ended up with a list of improvement actions aiming at strengthening the surgical checklist reliability and compliance. CONCLUSIONS: The perception of the surgical checklist usefulness as a tool to prevent adverse events was moderate among surgeons, but well appreciated by junior staff. Nursing staff were especially critical regarding compliance and support by other professionals. To reinforce the usefulness perception of the surgical checklist it is needed to increase the involvement of all professionals, especially senior staff and surgical leaders.

A randomised phase II study of osimertinib and bevacizumab versus osimertinib alone as second-line targeted treatment in advanced NSCLC with confirmed EGFR and acquired T790M mutations: the European Thoracic Oncology Platform (ETOP 10-16) BOOSTER trial.

BACKGROUND: While osimertinib, a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) is the standard treatment in patients with advanced non-small-cell lung cancer (NSCLC) with sensitising EGFR and acquired T790M mutations, progression inevitably occurs. The angiogenic pathway is implicated in EGFR TKI resistance. PATIENTS AND METHODS: BOOSTER is an open-label randomised phase II trial investigating the efficacy and safety of combined osimertinib 80 mg daily and bevacizumab 15 mg/kg every 3 weeks, versus osimertinib alone, in patients with EGFR-mutant advanced NSCLC and acquired T790M mutations after failure on previous EGFR TKI therapy. Primary endpoint was investigator-assessed progression-free survival (PFS). Secondary endpoints were overall survival (OS), objective response rate (ORR) and adverse events (AEs). RESULTS: Between May 2017 and February 2019, 155 patients were randomised (combination: 78; osimertinib: 77). At data cut-off of 22 February 2021, median follow-up was 33.8 months [interquartile range (IQR): 26.5-37.6 months] and 129 (83.2%) PFS events were reported in the intention-to-treat population. There was no difference in median PFS between the combination [15.4 months; 95% confidence interval (CI) 9.2-18.0 months] and osimertinib arm (12.3 months; 95% CI 6.2-17.2 months; stratified log-rank P = 0.83), [hazard ratio (HR) = 0.96; 95% CI 0.68-1.37]. Median OS was 24.0 months (95% CI 17.8-32.1 months) in the combination arm and 24.3 months (95% CI 16.9-37.0 months) in the osimertinib arm (stratified log-rank P = 0.91), (HR = 1.03; 95% CI 0.67-1.56). Exploratory analysis revealed a significant interaction of smoking history with treatment for PFS (adjusted P = 0.0052) with a HR of 0.52 (95% CI 0.30-0.90) for smokers, and 1.47 (95% CI 0.92-2.33) for never smokers. ORR was 55% in both arms and the median time to treatment failure was significantly shorter in the combination than in the osimertinib arm, 8.2 months versus 10.8 months, respectively (P = 0.0074). Safety of osimertinib and bevacizumab was consistent with previous reports with grade ≥3 treatment-related AEs (TRAEs) reported in 47% and 18% of patients on combination and osimertinib alone, respectively. CONCLUSIONS: No difference in PFS was observed between osimertinib plus bevacizumab and osimertinib alone. Grade ≥3 TRAEs were more common in patients on combination.

[Dual performance paradigms: their conceptual aspects]. / Paradigmas de ejecución dual: aspectos conceptuales.

INTRODUCTION: Dual-task paradigms (or dual performance tasks) are involved in a wide variety of multiple activities in our daily lives, as they are considered an evolutionary advantage of the phylogeny that makes it possible to perform several tasks at the same time with an optimisation of the 'neural resources' compared to tasks that would otherwise be carried out as a single task. DEVELOPMENT: The literature related to three dual-task performance paradigms is reviewed: a) the cognitive/motor paradigm, referring to models that involve a task with a cognitive component and a task with a motor component; b) the motor/motor paradigm, referring to a motor task and a simultaneous motor task, and c) the cognitive/cognitive paradigm, in which a task with a cognitive component and a cognitive task are involved. CONCLUSIONS: Dual tasks are an efficient tool for detecting mild cognitive impairment, as well as an ideal paradigm for rehabilitation intervention, given the increased attentional resources and executive functions involved in performing them. Neuroimaging can be a valuable tool that makes it possible to: a) locate the cognitive, motor and/or perceptual processes involved in the different dual performance paradigms; b) characterise the responses and function of specific brain signals in each of the tasks, and c) relate changes in neural activity to the efficacy of different intervention programmes.

TITLE: Paradigmas de ejecución dual: aspectos conceptuales.Introducción. Los paradigmas de doble tarea (o tareas de ejecución dual) se hallan implicados en múltiples y variadas actividades de nuestra vida cotidiana, ya que se consideran una ventaja evolutiva de la filogenia que posibilita llevar a cabo varias tareas al mismo tiempo con una optimización 'de los recursos neuronales' en comparación con las tareas que, por el contrario, se realizarían como una tarea única o simple. Desarrollo. Se revisa la bibliografía relacionada con tres paradigmas de ejecución de doble tarea: a) paradigma cognitivo/motor que hace referencia a modelos, en los que se hallan implicadas una tarea con un componente cognitivo y una tarea con un componente motor; b) paradigma motor/motor que hace referencia a una tarea motora y una tarea simultánea también motora, y c) paradigma cognitivo/cognitivo, en el que se implican una tarea con un componente cognitivo y otra también cognitiva. Conclusiones. Las tareas duales son una eficiente herramienta para detectar el deterioro cognitivo leve, así como un paradigma idóneo para la intervención en rehabilitación, dado el incremento de recursos atencionales y funciones ejecutivas implicados en su ejecución. En cuanto a la neuroimagen, ésta puede aportar: a) localizar los procesos cognitivos, motores y/o perceptivos implicados en los diferentes paradigmas de ejecución dual; b) caracterizar las respuestas y función de determinadas señales cerebrales en cada una de las tareas, y c) relacionar modificaciones en la actividad neural con la eficacia de diferentes programas de intervención.

Paradigmas de ejecución dual: aspectos conceptuales / Dual performance paradigms: their conceptual aspects

Introducción: Los paradigmas de doble tarea (o tareas de ejecución dual) se hallan implicados en múltiples y variadas actividades de nuestra vida cotidiana, ya que se consideran una ventaja evolutiva de la filogenia que posibilita llevar a cabo varias tareas al mismo tiempo con una optimización ‘de los recursos neuronales’ en comparación con las tareas que, por el contrario, se realizarían como una tarea única o simple. Desarrollo: Se revisa la bibliografía relacionada con tres paradigmas de ejecución de doble tarea: a) paradigma cognitivo/motor que hace referencia a modelos, en los que se hallan implicadas una tarea con un componente cognitivo y una tarea con un componente motor; b) paradigma motor/motor que hace referencia a una tarea motora y una tarea simultánea también motora, y c) paradigma cognitivo/cognitivo, en el que se implican una tarea con un componente cognitivo y otra también cognitiva. Conclusiones: Las tareas duales son una eficiente herramienta para detectar el deterioro cognitivo leve, así como un paradigma idóneo para la intervención en rehabilitación, dado el incremento de recursos atencionales y funciones ejecutivas implicados en su ejecución. En cuanto a la neuroimagen, ésta puede aportar: a) localizar los procesos cognitivos, motores y/o perceptivos implicados en los diferentes paradigmas de ejecución dual; b) caracterizar las respuestas y función de determinadas señales cerebrales en cada una de las tareas, y c) relacionar modificaciones en la actividad neural con la eficacia de diferentes programas de intervención.(AU)

Introduction: Dual-task paradigms (or dual performance tasks) are involved in a wide variety of multiple activities in our daily lives, as they are considered an evolutionary advantage of the phylogeny that makes it possible to perform several tasks at the same time with an optimisation of the ‘neural resources’ compared to tasks that would otherwise be carried out as a single task. Development: The literature related to three dual-task performance paradigms is reviewed: a) the cognitive/motor paradigm, referring to models that involve a task with a cognitive component and a task with a motor component; b) the motor/motor paradigm, referring to a motor task and a simultaneous motor task, and c) the cognitive/cognitive paradigm, in which a task with a cognitive component and a cognitive task are involved. Conclusions: Dual tasks are an efficient tool for detecting mild cognitive impairment, as well as an ideal paradigm for rehabilitation intervention, given the increased attentional resources and executive functions involved in performing them. Neuroimaging can be a valuable tool that makes it possible to: a) locate the cognitive, motor and/or perceptual processes involved in the different dual performance paradigms; b) characterise the responses and function of specific brain signals in each of the tasks, and c) relate changes in neural activity to the efficacy of different intervention programmes.(AU)

Differential recruitment of opportunistic taxa leads to contrasting abilities in carbon processing by bathypelagic and surface microbial communities.

Different factors affect the way dissolved organic matter (DOM) is processed in the ocean water column, including environmental conditions and the functional capabilities of the communities. Recent studies have shown that bathypelagic prokaryotes are metabolically flexible, but whether this versatility translates into a higher ability to process DOM has been barely explored. Here we performed a multifactorial transplant experiment to compare the growth, activity and changes in DOM quality in surface and bathypelagic waters inoculated with either surface or bathypelagic prokaryotic communities. The effect of nutrient additions to surface waters was also explored. Despite no differences in the cell abundance of surface and deep ocean prokaryotes were observed in any of the treatments, in surface waters with nutrients the heterotrophic production of surface prokaryotes rapidly decreased. Conversely, bathypelagic communities displayed a sustained production throughout the experiment. Incubations with surface prokaryotes always led to a significant accumulation of recalcitrant compounds, which did not occur with bathypelagic prokaryotes, suggesting they have a higher ability to process DOM. These contrasting abilities could be explained by the recruitment of a comparatively larger number of opportunistic taxa within the bathypelagic assemblages, which likely resulted in a broader community capability of substrate utilization.

Seasonal impact of grazing, viral mortality, resource availability and light on the group-specific growth rates of coastal Mediterranean bacterioplankton.

Estimation of prokaryotic growth rates is critical to understand the ecological role and contribution of different microbes to marine biogeochemical cycles. However, there is a general lack of knowledge on what factors control the growth rates of different prokaryotic groups and how these vary between sites and along seasons at a given site. We carried out several manipulation experiments during the four astronomical seasons in the coastal NW Mediterranean in order to evaluate the impact of grazing, viral mortality, resource competition and light on the growth and loss rates of prokaryotes. Gross and net growth rates of different bacterioplankton groups targeted by group-specific CARD-FISH probes and infrared microscopy (for aerobic anoxygenic phototrophs, AAP), were calculated from changes in cell abundances. Maximal group-specific growth rates were achieved when both predation pressure and nutrient limitation were experimentally minimized, while only a minimal effect of viral pressure on growth rates was observed; nevertheless, the response to predation removal was more remarkable in winter, when the bacterial community was not subjected to nutrient limitation. Although all groups showed increases in their growth rates when resource competition as well as grazers and viral pressure were reduced, Alteromonadaceae consistently presented the highest rates in all seasons. The response to light availability was generally weaker than that to the other factors, but it was variable between seasons. In summer and spring, the growth rates of AAP were stimulated by light whereas the growth of the SAR11 clade (likely containing proteorhodopsin) was enhanced by light in all seasons. Overall, our results set thresholds on bacterioplankton group-specific growth and mortality rates and contribute to estimate the seasonally changing contribution of various bacterioplankton groups to the function of microbial communities. Our results also indicate that the least abundant groups display the highest growth rates, contributing to the recycling of organic matter to a much greater extent than what their abundances alone would predict.