The reorganization of predator-prey networks over 20 million years explains extinction patterns of mammalian carnivores.

Linking the species interactions occurring at the scale of local communities to their potential impact at evolutionary timescales is challenging. Here, we used the high-resolution fossil record of mammals from the Iberian Peninsula to reconstruct a timeseries of trophic networks spanning more than 20 million years and asked whether predator-prey interactions affected regional extinction patterns. We found that, despite small changes in species richness, trophic networks showed long-term trends, gradually losing interactions and becoming sparser towards the present. This restructuring of the ecological networks was driven by the loss of medium-sized herbivores, which reduced prey availability for predators. The decrease in prey availability was associated with predator longevity, such that predators with less available prey had greater extinction risk. These results not only reveal long-term trends in network structure but suggest that prey species richness in ecological communities may shape large scale patterns of extinction and persistence among predators.

Porcine Forebrain Vacuolization Associated with Wasting in Pigs: A Novel Pathological Outcome Associated with Vitamin-Mineral Deficiency?

The term wasting refers to a clinical sign used to describe a physical condition characterized by growth retardation, usually of multifactorial origin. The objective of the present study was to describe for the first time a pathological process characterized by forebrain neuropil vacuolization in pigs showing wasting without conspicuous neurological signs. To characterize the lesions pathologically, affected and non-affected pigs from eight of these farms were investigated. Histologically, the most consistent lesion was neuropil vacuolization of the prosencephalon, mainly located in the thalamic nuclei and in the transition between the white and grey matter of the neocortex (40/56 in sick and 4/30 in healthy pigs). In the most severe cases, the vacuolation also involved the midbrain, cerebellar nuclei and, to a lesser extent, the medulla oblongata. Vacuolization of the forebrain was associated with pigs experiencing marked emaciation and growth retardation. Although the specific cause of the present case remained unknown, the preventive use of multivitamin and mineral complexes in drinking water ameliorated the condition, strongly suggesting a metabolic origin of the observed condition.

Underreporting and Underrepresentation of Racial and Ethnic Minority Patients in Lymphedema Clinical Trials: A Systematic Review.

The generalizability of findings from Clinical Trials (CTs) investigating lymphedema treatment modalities requires an accurate representation of the target population. This study aims to evaluate racial and ethnic reporting and representation in lymphedema CTs. A comprehensive systematic literature search was conducted during May 2023 using multiple databases, following the PRISMA guidelines. All CTs published from 2018 to 2023 were included. A total of 84 articles were included in this review, from which 6,546 participants were included in the analysis. Seventy-four (88.1%) articles addressed secondary lymphedema, of which 60 (81.1%) were related to breast cancer. Only 12 (13%) of CTs reported at some extend race or ethnicity. Of these, five (41.6%) reported race and two (16.6%) reported ethnicity according to FDA guidelines. White race had the highest pooled prevalence (80%; 95% CI 72-86%; I2=90%), followed by Black (7%; 95% CI 2- 15%; I2= 94.3%) and Asian (4%; 95% CI 1-8%; I2= 89.9%). In studies reporting ethnicity, participants were predominantly non-Hispanic (92.1%; 95% CI 90 - 94%). There is an underreporting and underrepresentation of racial and ethnic minorities among lymphedema CTs, limiting their generalizability. It is imperative to future development of strategies to enhance diversity in the study sample.

Long-term treatment with nebulized colistin in oncological patients with recurrent respiratory infections

Objectives: To assess the efficacy of long-term treatment with nebulized colistin in reducing the number of respiratory infections, emergency consultations and hospitalizations in oncological patients.MethodsA retrospective, observational, single-centre study including patients with solid or haematologic malignancies, or pulmonary GVHD after HSTC who received treatment with nebulized colistin for at least six-months to prevent recurrent respiratory infections (July 2010 to June 2017).ResultsTwelve patients were included (median age: 54.4, range: 23–85), 7 with solid malignancies and 5 with haematologic malignancies (2 with pulmonary GVHD). Pseudomonas aeruginosa was the most frequent microorganism in sputum cultures (11/12 patients), all strains were susceptible to colistin. There was a statistically significant reduction (p=0.01) in respiratory infections in the six-month period after starting colistin (median: 1, range: 0–4) compared to the six-month period before (median: 4, range: 1–8). There was also a reduction in emergency consultations (precolistin: median: 1.50, range: 0–3; postcolistin: median: 0, range: 0–3) and hospitalizations (precolistin: median: 1.50, range: 0–3; postcolistin: median: 0, range: 0–3) due to respiratory infections. No colistin-resistant strains were identified.ConclusionsLong-term treatment with nebulized colistin may be useful to reduce the number of exacerbations in oncological patients with recurrent respiratory infections. (AU)

Objetivos: Evaluar la eficacia de un tratamiento prolongado con colistina nebulizada para reducir el número de infecciones respiratorias, consultas en Urgencias y hospitalizaciones en pacientes oncológicos.MétodosEstudio retrospectivo, observacional y unicéntrico en pacientes con neoplasias sólidas o hematológicas o EICR pulmonar tras TPH tratados con colistina nebulizada al menos 6 meses para prevenir infecciones respiratorias recurrentes (julio del 2010-junio del 2017).ResultadosSe incluyó a 12 pacientes (edad mediana 54,4, rango: 23-85), 7 con cáncer sólido y 5 con neoplasias hematológicas (2 con EICR pulmonar). El microorganismo aislado más frecuentemente en esputos fue Pseudomonasaeruginosa (11/12 pacientes); todas las cepas fueron colistina-sensibles. Se evidenciaron una reducción estadísticamente significativa (p = 0,01) de las infecciones respiratorias en los 6 meses tras iniciar colistina (mediana: 1, rango: 0-4) comparado con los 6 meses previos (mediana: 4, rango: 1-8), y una reducción del número de visitas a Urgencias (precolistina: mediana: 1,50, rango: 0-3; postcolistina: mediana: 0, rango: 0-3) y hospitalizaciones (precolistina: mediana: 1,50, rango: 0-3; postcolistina: mediana: 0, rango: 0-3) por infección respiratoria. No se detectaron cepas resistentes a colistina.ConclusionesUn tratamiento prolongado con colistina nebulizada puede ser útil para reducir el número de exacerbaciones en pacientes oncológicos con infecciones respiratorias recurrentes. (AU)

CVD-MET: an image difference metric designed for analysis of color vision deficiency aids.

Color vision deficiency (CVD) has gained in relevance in the last decade, with a surge of proposals for aid systems that aim to improve the color discrimination capabilities of CVD subjects. This paper focuses on the proposal of a new metric called CVD-MET, that can evaluate the efficiency and naturalness of these systems through a set of images using a simulation of the subject's vision. In the simulation, the effect of chromatic adaptation is introduced via CIECAM02, which is relevant for the evaluation of passive aids (color filters). To demonstrate the potential of the CVD-MET, an evaluation of a representative set of passive and active aids is carried out both with conventional image quality metrics and with CVD-MET. The results suggest that the active aids (recoloration algorithms) are in general more efficient and produce more natural images, although the changes that are introduced do not shift the CVD's perception of the scene towards the normal observer's perception.

Perceptions of Heat Stress, Heat Strain and Mitigation Practices in Wildfire Suppression across Southern Europe and Latin America.

This study aimed to assess current perceptions of heat stress, heat strain, acclimatisation and recovery practices in wildland fire suppression. A total of 1459 wildfire and structural firefighters, all involved in wildland fire suppression, completed an 18-question survey. Most participants (81.3%) reported heat strain as one of the main risks faced during wildland firefighting. Thermal strain is considered an important risk for health and safety in wildland firefighting. The best-valued heat strain mitigation strategies were those traditionally recommended in wildland fire suppression: (i) an adequate work/rest ratio (79.0%), (ii) acclimatisation (71.6%), (iii) enhancing body ventilation by opening protective clothing or removing helmets or gloves (63.5%), and (iv) drinking water and food supplementation (52.1%). Despite these results, only 22% of the participants reported carrying out acclimatisation in the workplace. The vast majority of the respondents (87.4%) consider active cooling strategies (i.e., ice slurry ingestion, ice vests, etc.) impractical in combating heat strain during wildfire suppression. We identified a gap between knowledge about heat strain, its mitigation strategies and the level of actual implementation of these practices in the workplace. Our results highlight the need to improve heat strain management and implement operational directives for acclimatisation and active cooling interventions.

Long-term treatment with nebulized colistin in oncological patients with recurrent respiratory infections.

OBJECTIVES: To assess the efficacy of long-term treatment with nebulized colistin in reducing the number of respiratory infections, emergency consultations and hospitalizations in oncological patients. METHODS: A retrospective, observational, single-centre study including patients with solid or haematologic malignancies, or pulmonary GVHD after HSTC who received treatment with nebulized colistin for at least six-months to prevent recurrent respiratory infections (July 2010 to June 2017). RESULTS: Twelve patients were included (median age: 54.4, range: 23-85), 7 with solid malignancies and 5 with haematologic malignancies (2 with pulmonary GVHD). Pseudomonas aeruginosa was the most frequent microorganism in sputum cultures (11/12 patients), all strains were susceptible to colistin. There was a statistically significant reduction (p=0.01) in respiratory infections in the six-month period after starting colistin (median: 1, range: 0-4) compared to the six-month period before (median: 4, range: 1-8). There was also a reduction in emergency consultations (precolistin: median: 1.50, range: 0-3; postcolistin: median: 0, range: 0-3) and hospitalizations (precolistin: median: 1.50, range: 0-3; postcolistin: median: 0, range: 0-3) due to respiratory infections. No colistin-resistant strains were identified. CONCLUSIONS: Long-term treatment with nebulized colistin may be useful to reduce the number of exacerbations in oncological patients with recurrent respiratory infections.

Reliability of a computer-aided system in the evaluation of indeterminate ultrasound images of thyroid nodules.

Introduction: Computer-aided diagnostic (CAD) programs for malignancy risk stratification from ultrasound (US) imaging of thyroid nodules are being validated both experimentally and in real-world practice. However, they have not been tested for reliability in analyzing difficult or unclear images. Methods: US images with indeterminate characteristics were evaluated by five observers with different experience in US examination and by a commercial CAD program. The nodules, on which the observers widely agreed, were considered concordant and, if there was little agreement, not concordant or difficult to assess. The diagnostic performance of the readers and the CAD program was calculated and compared in both groups of nodule images. Results: In the group of concordant thyroid nodules (n = 37), the clinicians and the CAD system obtained similar levels of accuracy (77.0% vs 74.2%, respectively; P = 0.7) and no differences were found in sensitivity (SEN) (95.0% vs 87.5%, P = 0.2), specificity (SPE) (45.5 vs 49.4, respectively; P = 0.7), positive predictive value (PPV) (75.2% vs 77.7%, respectively; P = 0.8), nor negative predictive value (NPV) (85.6 vs 77.7, respectively; P = 0.3). When analyzing the non-concordant nodules (n = 43), the CAD system presented a decrease in accuracy of 4.2%, which was significantly lower than that observed by the experts (19.9%, P = 0.02). Conclusions: Clinical observers are similar to the CAD system in the US assessment of the risk of thyroid nodules. However, the AI system for thyroid nodules AmCAD-UT® showed more reliability in the analysis of unclear or misleading images.

Efecto de la variabilidad glucémica intrahospitalaria en la mortalidad de los pacientes con diabetes / Effect of in-hospital glycemic variability on mortality in patients with diabetes

Introducción El objectivo fue evaluar la importancia de glucemia media (GM) y variabilidad glucémica (VG) durante la hospitalización sobre la mortalidad tras el alta.Material y métodosEstudio de cohortes retrospectivo longitudinal analítico. Se incluyeron pacientes dados de alta del Servicio de Medicina Interna con algún diagnóstico relacionado con la diabetes. El pronóstico evaluado fue la mortalidad. Se recogieron durante el ingreso variables clínicas, analíticas y relacionadas con el control glucémico hospitalario (GM, VG e hipoglucemias). La VG se midió con el coeficiente de variación (CV).Se calcularon las tasas de mortalidad por cada 1000 pacientes-año y se compararon con curvas de Kaplan-Meier. La determinación de los factores predictivos de mortalidad se realizó mediante regresión de Cox.ResultadosSe incluyeron 276 pacientes con edad media 77,6 (DE 10,2) años. La duración mediana del seguimiento extrahospitalario fue de 2,7 años.En análisis multivariante, una GM > 140 (HR=1,72; IC 95% 1,14-2,61; p=0,01) y un CV > 0,29 (HR=1,52; IC 95% 1,12-2,06; p=0,006), no así la presencia de hipoglucemias, se asociaron a incremento del riesgo de mortalidad de forma aditiva e independiente. Tener una GM > 140 simultáneamente con un CV > 0,29 incrementó las tasas de mortalidad (123 vs. 317 por 1.000 pacientes-año; p <0,001) y el riesgo ajustado de mortalidad (HR=2,70; IC 95% 1,71-4,27; p<0,001) respecto a tener una GM ≤ 140mg/dl.ConclusiónLa presencia simultánea de GM y VG elevadas constituye una potente herramienta de estratificación del riesgo de mortalidad tras el alta hospitalaria. (AU)

Introduction The aim of this study was to evaluate the impact of mean blood glucose (MBG) and glycaemic variability (GV) during hospitalisation on mortality after discharge.Material and methodsWe conducted a retrospective longitudinal analytical cohort study that included patients discharged form a department of internal medicine with a diabetes-related diagnosis The evaluated prognosis was mortality. During hospitalisation, the patients’ clinical, laboratory and glycaemic control-related variables were recorded (MBG, GV and hypoglycaemia). The GV was measured with the coefficient of variation (CV).We calculated the mortality rates for every 1000 patient-years and compared them with Kaplan-Meier curves. We determined the predictors of mortality by performing a Cox regression.ResultsThe study included 276 patients with a mean age of 77.6 (SD, 10.2) years. The median outpatient follow-up duration was 2.7 years.In the multivariate analysis, an MBG >140mg/dl (HR, 1.72; 95% CI 1.14–2.61; p=.01) and a CV >0.29 (HR, 1.52; 95% CI 1.12–2.06; p=.006) but not the presence of hypoglycaemia were additively and independently associated with an increased risk of mortality. An MBG >140mg/dl with a CV >0.29 increased the mortality rates (123 vs. 317 per 1000 patient-year; p <.001) and the adjusted mortality risk (HR, 2.70; 95% CI 1.71–4.27; p<.001) compared with having an MBG ≤140mg/dl.ConclusionThe simultaneous presence of a high MBG level and CV constitutes a powerful tool for stratifying mortality risk after hospital discharge. (AU)

One year of the pandemic - how European endocrinologists responded to the crisis: a statement from the European Society of Endocrinology.

Changes that COVID-19 induced in endocrine daily practice as well as the role of endocrine and metabolic comorbidities in COVID-19 outcomes were among the striking features of this last year. The aim of this statement is to illustrate the major characteristics of the response of European endocrinologists to the pandemic including the disclosure of the endocrine phenotype of COVID-19 with diabetes, obesity and hypovitaminosis D playing a key role in this clinical setting with its huge implication for the prevention and management of the disease. The role of the European Society of Endocrinology (ESE) as a reference point of the endocrine community during the pandemic will also be highlighted, including the refocusing of its educational and advocacy activities.

Effect of in-hospital glycemic variability on mortality in patients with diabetes.

INTRODUCTION: The aim of this study was to evaluate the impact of mean blood glucose (MBG) and glycaemic variability (GV) during hospitalisation on mortality after discharge. MATERIAL AND METHODS: We conducted a retrospective longitudinal analytical cohort study that included patients discharged form a department of internal medicine with a diabetes-related diagnosis. The evaluated prognosis was mortality. During hospitalisation, the patients' clinical, laboratory and glycaemic control-related variables were recorded (MBG, GV and hypoglycaemia). The GV was measured with the coefficient of variation (CV). We calculated the mortality rates for every 1000 patient-years and compared them with Kaplan-Meier curves. We determined the predictors of mortality by performing a Cox regression. RESULTS: The study included 276 patients with a mean age of 77.6 (SD, 10.2) years. The median outpatient follow-up duration was 2.7 years. In the multivariate analysis, an MBG > 140 mg/dL (HR = 1.72; 95% CI 1.14-2.61; p = .01) and a CV > 0.29 (HR = 1.52; 95% CI 1.12-2.06; p = .006), but not the presence of hypoglycaemia, were additively and independently associated with an increased risk of mortality. An MG > 140 mg/dL with a CV > 0.29 increased the mortality rates (123 vs. 317 per 1000 patient-year; p < .001) and the adjusted mortality risk (HR = 2.70; 95% CI 1.71-4.27; p < .001) compared with having an MBG ≤ 140 mg/dL. CONCLUSION: The simultaneous presence of a high MBG level and CV constitutes a powerful tool for stratifying mortality risk after hospital discharge.

COVID-19 and endocrine and metabolic diseases. An updated statement from the European Society of Endocrinology.

BACKGROUND: COVID-19 has completely changed our daily clinical practice as well as our social relations. Many organs and biological systems are involved in SARS-Cov-2 infection, either due to direct virus-induced damage or to indirect effects that can have systemic consequences. Endocrine system is not only an exception but its involvement in COVID-19 is so relevant that an "endocrine phenotype" of COVID-19 has progressively acquired clinical relevance. AIM: We have been appointed by the European Society of Endocrinology (ESE) to update with the current statement ESE members and the whole endocrine community on the emerging endocrine phenotype of COVID-19 and its implication for the prevention and management of the disease. CONCLUSIONS: Diabetes has a major role in this phenotype since it is one of the most frequent comorbidities associated with severity and mortality of COVID-19. Careful management including treatment modifications may be required for protecting our patients rather with known diabetes from the most dangerous consequences of COVID-19 or hospitalized with COVID-19, but also in patients with SARS-CoV-2 induced newly onset diabetes. Obesity increases susceptibility to SARS-CoV-2 and the risk for COVID-19 adverse outcome. Adequate nutritional management needs to be granted to patients with obesity or undernourishment in order to limit their increased susceptibility and severity of COVID-19 infection. Lack of vitamin D, hypocalcemia and vertebral fractures have also emerged as frequent findings in the hospitalized COVID-19 population and may negatively impact on the outcome of such patients. Also, in patients with adrenal insufficiency prompt adaptation of glucocorticoid doses may be needed. Moreover, in this updated statement role of sex hormones as well as peculiar pituitary and thyroid aspects of COVID-19 have been included. Finally, in view of the mass vaccination, potential implications for endocrine patients should be considered.

Punctuated ecological equilibrium in mammal communities over evolutionary time scales.

The study of deep-time ecological dynamics has the ability to inform conservation decisions by anticipating the behavior of ecosystems millions of years into the future. Using network analysis and an exceptional fossil dataset spanning the past 21 million years, we show that mammalian ecological assemblages undergo long periods of functional stasis, notwithstanding high taxonomic volatility due to dispersal, speciation, and extinction. Higher functional richness and diversity promoted the persistence of functional faunas despite species extinction risk being indistinguishable among these different faunas. These findings, and the large mismatch between functional and taxonomic successions, indicate that although safeguarding functional diversity may or may not minimize species losses, it would certainly enhance the persistence of ecosystem functioning in the face of future disturbances.

Particle size and cholesterol content of circulating HDL correlate with cardiovascular death in chronic heart failure.

Evidence regarding any association of HDL-particle (HDL-P) derangements and HDL-cholesterol content with cardiovascular (CV) death in chronic heart failure (HF) is lacking. To investigate the prognostic value of HDL-P size (HDL-Sz) and the number of cholesterol molecules per HDL-P for CV death in HF patients. Outpatient chronic HF patients were enrolled. Baseline HDL-P number, subfractions and HDL-Sz were measured using 1H-NMR spectroscopy. The HDL-C/P ratio was calculated as HDL-cholesterol over HDL-P. Endpoint was CV death, with non-CV death as the competing event. 422 patients were included and followed-up during a median of 4.1 (0-8) years. CV death occurred in 120 (30.5%) patients. Mean HDL-Sz was higher in CV dead as compared with survivors (8.39 nm vs. 8.31 nm, p < 0.001). This change in size was due to a reduction in the percentage of small HDL-P (54.6% vs. 60% for CV-death vs. alive; p < 0.001). HDL-C/P ratio was higher in the CV-death group (51.0 vs. 48.3, p < 0.001). HDL-Sz and HDL-C/P ratio were significantly associated with CV death after multivariable regression analysis (HR 1.22 [95% CI 1.01-1.47], p = 0.041 and HR 1.04 [95% CI 1.01-1.07], p = 0.008 respectively). HDL-Sz and HDL-C/P ratio are independent predictors of CV death in chronic HF patients.

In Vitro and In Vivo Antibacterial Activity of Gliotoxin Alone and in Combination with Antibiotics against Staphylococcus aureus.

Multidrug-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) is one of the major causes of hospital-acquired and community infections and pose a challenge to the human health care system. Therefore, it is important to find new drugs that show activity against these bacteria, both in monotherapy and in combination with other antimicrobial drugs. Gliotoxin (GT) is a mycotoxin produced by Aspergillus fumigatus and other fungi of the Aspergillus genus. Some evidence suggests that GT shows antimicrobial activity against S. aureus in vitro, albeit its efficacy against multidrug-resistant strains such asMRSA or vancomycin-intermediate S. aureus (VISA) strainsis not known. This work aimedto evaluate the antibiotic efficacy of GT as monotherapy or in combination with other therapeutics against MRSA in vitro and in vivo using a Caenorhabditis elegans infection model.