Long-Term Treatment with Alcaligenes faecalis A12C Improves Host Resistance to Pathogens in Septic Rats: Possible Contribution of Curdlan-Like Immune Trainer.

Curdlan, a ß-1,3/1,6-glucan found in Alcaligenes faecalis (A. faecalis) wall, activates innate and humoral immunity. The aim of this study is to evaluate whether pretreated rats with A. faecalis A12C could prevent sepsis disturbances and identify the immunomodulatory mechanisms involved. Experiments occurred in two stages: a survival study with 16 rats randomly divided into septic (SC) (n = 8) and septic pretreated (SA) (n = 8) groups and 45 rats divided into four groups: healthy (AGUSAN) (n = 9), septic (AGUIC) (n = 13), septic pretreated (AGUIA) (n = 14), and healthy pretreated (AGUSTO) (n = 9). Sepsis was induced by cecal ligation and puncture after 30 days of A. faecalis A12C pretreatment or without. SA group had a higher survival rate of 58% vs. 16% for SC group (P < 0.05). Overall, AGUIA showed better status than AGUIC (P < 0.01). Higher monocytosis was found in AGUIA and AGUSTO vs. AGUIC and AGUSAN, respectively (P < 0.05). A gradual increase in curdlan fecal concentration was observed in AGUIA during pretreatment. Fecal concentrations of Escherichia coli significantly decreased in AGUIA and AGUSTO. Bacterial load in urine, peritoneal lavage fluid (PLF), and bronchoalveolar lavage fluid (BALF) decreased (P < 0.05) in AGUIA vs. AGUIC. Finally, lower inflammation was observed in serum, BALF, and PLF, with reduced IL-6, IL-10, IL-1ß, and TNF-α, along with less damage in lungs and peritoneum in AGUIA vs. AGUIC. These findings suggest the connection between curdlan-produced by A. faecalis A12C-with the immune system and the reduction in severity of experimental sepsis.

2†Pathways to detection of non-infectious childhood uveitis in the UK: findings from the UNICORN cohort study.

INTRODUCTION: Prompt detection of childhood uveitis is key to minimising negative impact. From an internationally unique inception cohort, we report pathways to disease detection.UNICORNS is a national childhood non-infectious uveitis study with longitudinal collection of a standardised clinical dataset and patient reported outcomes. Descriptive analysis of baseline characteristics are reported.Amongst 150 recruited children (51% female, 31% non-white ethnicity) age at detection ranged from 2-18yrs (median 10). In 69%, uveitis was diagnosed following onset of symptoms: time from first symptoms to uveitis detection ranged from 0-739days (median 7days), with longer time to detection for those presenting initially to their general practitioner. Non symptomatic children were detected through JIA/other disease surveillance (16%), routine optometry review (5%) or child visual health screening (1%). Commonest underlying diagnoses at uveitis detection were JIA (17%), TINU (9%, higher than pre-pandemic reported UK disease frequency) and sarcoid (1%). 60% had no known systemic disease at uveitis detection. At disease detection, in at least one eye: 34% had structural complications (associated with greater time to detection - 17 days versus 4 days for uncomplicated presentation).The larger relative proportions of children with non-JIA uveitis reported here increase the importance of improving awareness of childhood uveitis amongst the wider clinical communities. There is scope for improvement of pathways to detection. Forthcoming analysis on the full cohort (251 recruited to date across 33 hospitals and 4 nations) will provide nationally representative data on management and the determinants of visual and broader developmental/well-being outcomes.

Complications of HIPEC for ovarian cancer surgery: evaluation over two time periods.

OBJECTIVE: Cytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy (HIPEC) is being explored in the upfront, interval, and recurrent setting in patients with ovarian cancer. The objective of this systematic review was to assess the rate of complications associated with HIPEC in epithelial ovarian cancer surgery over two time periods. METHODS: This study was registered in PROSPERO (CRD42022328928). A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Ovid/Medline, Ovid/Embase, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials were searched from January 2004 to April 2022. We included studies reporting on patients with advanced primary or recurrent epithelial ovarian cancer who underwent cytoreductive surgery and HIPEC. We evaluated two different time periods: 2004-2013 and 2014-2022. A random-effects meta-analysis was used to produce an overall summary. Subgroup analyses were planned according to recruited period for each specific complication type. Heterogeneity was assessed using the I2 statistic. RESULTS: A total of 4928 patients were included from 69 studies for this systematic review; 19 published from 2004-2013, and 50 published from 2014-2022. No significant differences were found between the two time periods in terms of blood transfusions (33% vs 51%; p=0.46; I2=95%) overall gastrointestinal complications (15% vs 21%; p=0.36; I2=98%), infectious diseases (16% vs 13%; p=0.62; I2=93%), overall respiratory complications (12% vs 12%; p=0.88; I2=91%), overall urinary complications (6% vs 12%; p=0.06; I2=94%), or thromboembolic events (5% vs 3%; p=0.25; I2=63%). Also, no differences were found in intensive care unit (ICU) admissions (89% vs 28%; p=0.06; I2=99%), reoperations (8% vs 7%; p=0.50; I2=37%), or deaths (3% vs 3%; p=0.77; I2=57%). CONCLUSIONS: Our review showed that overall complications have not changed over time for patients undergoing HIPEC in the setting of primary or recurrent ovarian cancer. There was no decrease in the rates of ICU admissions, reoperations, or deaths.

Immunoglobulins in systemic sclerosis management. A large multicenter experience.

OBJECTIVE: To analyze the effectiveness and safety of intravenous immunoglobulin (IVIG) given in routine care to patients with systemic sclerosis (SSc). METHODS: A retrospective multicenter observational study was conducted in SSc patients treated with IVIG. We collected data on epidemiological parameters and clinical outcomes. Firstly, we assessed changes in organ manifestations during IVIG treatment. Secondly, we analyzed the frequency of adverse effects. The following parameters were collected from baseline to the last follow-up: the patient's weight, modified Rodnan Skin Score (mRSS), modified manual muscle strength scale (MRC), laboratory test(creatine kinase(CK), hemoglobin and protein levels), The University of California Los Angeles Scleroderma Clinical Trials Consortium gastrointestinal tract 2.0 (UCLA GIT 2.0) questionnaire, pulmonary function tests, and echocardiography. RESULTS: Data were collected on 78 patients (82% females; 59% with diffuse SSc). Inflammatory idiopathic myopathy was the most frequent concomitant overlap disease (41%). The time since Raynaud's phenomenon and SSc onset were 8.8 ± 18 and 6.2 ± 6.7 years respectively. The most frequent IVIG indication was myositis (38/78), followed by gastrointestinal (27/78) and cutaneous (17/78) involvement. The median number of cycles given were 5. 54, 53 and 9 patients have been treated previously with glucocorticoids, synthetic disease-modifying antirheumatic drugs and biologic therapies respectively. After IVIG use we found significant improvements in muscular involvement (MRC ≥ 3/5 92% IVIG, p = 0.001 and CK levels from 1149 ± 2026 UI to 217 ± 224 UI, p = 0.02), mRSS (15 ± 12.4 to 13 ± 12.5, p = 0.015) and improvement in total score of UCLA GIT 2.0 (p = 0.05). None Anti-RNA polymerase III patients showed an adequate response in gastrointestinal involvement (0/7) in comparison with other antibodies (0 vs. 25, p = 0,039). Cardiorespiratory involvement remained stable. A total of 12 adverse events were reported with only one withdrawn due to serious adverse effect. CONCLUSIONS: this study suggest that IVIG may improve myositis, gastrointestinal and skin involvement in SSc patients treated in routine care and seems to have a good safety profile.

Diastolic Mitral Regurgitation as a Rare Cause of Acute Respiratory Failure Following Complete Atrioventricular Block.

A 77-year-old male presented to the emergency department with dyspnea. A third-degree atrioventricular block was present in the electrocardiogram and an echocardiography showed a moderate mitral regurgitation with a diastolic functional insufficiency. Hemodynamic variations were assessed in the context of heart rhythm disturbances. (Level of Difficulty: Intermediate.).

Active Control of Alfvén Eigenmodes by Externally Applied 3D Magnetic Perturbations.

The suppression and excitation of Alfvén eigenmodes have been experimentally obtained, for the first time, by means of externally applied 3D perturbative fields with different spatial spectra in a tokamak plasma. The applied perturbation causes an internal fast-ion redistribution that modifies the phase-space gradients responsible for driving the modes, determining, ultimately their existence. Hybrid kinetic-magnetohydrodynamic simulations reveal an edge resonant transport layer activated by the 3D perturbative field as the responsible mechanism for the fast-ion redistribution. The results presented here may help to control fast-ion driven Alfvénic instabilities in future burning plasmas with a significant fusion born alpha particle population.

Cardiogenic shock code 2023. Expert document for a multidisciplinary organization that allows quality care.

Despite the efforts made to improve the care of cardiogenic shock (CS) patients, including the development of mechanical circulatory support (MCS), the prognosis of these patients continues to be poor. In this context, CS code initiatives arise, based on providing adequate, rapid, and quality care to these patients. In this multidisciplinary document we try to justify the need to implement the SC code, defining its structure/organization, activation criteria, patient flow according to care level, and quality indicators. Our specific purposes are: a) to present the peculiarities of this condition and the lessons of infarction code and previous experiences in CS; b) to detail the structure of the teams, their logistics and the bases for the management of these patients, the choice of the type of MCS, and the moment of its implantation, and c) to address challenges to SC code implementation, including the uniqueness of the pediatric SC code. There is an urgent need to develop protocolized, multidisciplinary, and centralized care in hospitals with a large volume and experience that will minimize inequity in access to the MCS and improve the survival of these patients. Only institutional and structural support from the different administrations will allow optimizing care for CS.

Identificación de factores que se asocian a alto riesgo de desarrollar diabetes gestacional / Identification of factors associated with a high risk of developing gestational diabetes

Objetivos: Principal. Determinar la prevalencia de los factores de riesgo reconocidos para diabetes gestacional (DG) en nuestra población. Definir el perfil de las pacientes con mayor riesgo de desarrollar DG. Secundario. Analizar la aceptabilidad por parte de las gestantes de las pruebas de cribado. Material y método: Se trata de un estudio observacional ambispectivo en el que se reclutaron 1448 gestantes en un único centro, entre el 1 de diciembre de 2017 y el 31 de julio de 2019. Los criterios de inclusión fueron: no antecedente de diabetes mellitus pregestacional, no antecedente de DG en gestación previa, no antecedentes de cirugía bariátrica, haber realizado cribado para DG en la actual gestación. Resultados: La prevalencia de DG en nuestra población fue del 6,7%. Los factores de riesgo que se asociaron con el desarrollo de DG en nuestra población fueron: edad≥27,5 años (OR: 3,8; IC95%: 2,01-9,16), IMC≥28,5kg/m2 (OR: 2,3; IC95%:1,47-3,59); antecedente de diabetes mellitus en familiares de primer grado (OR: 2,3; IC95%: 1,5-3,66) y la gestación múltiple (OR: 2,8; IC95%: 0,86-6,36). La prevalencia de la DG se incrementó según lo hacía el número de factores de riesgo encontrados en la gestante: desde el 1,4% en las pacientes sin los factores de riesgo hasta el 25.2% con 3 factores de riesgo presentes. El 26,8% de las pacientes calificaron como desagradable la realización del test de ÓSullivan (50g glucosa) y el 65,4% la prueba de sobrecarga oral con 100g de glucosa. Conclusiones: La edad de la gestante≥27,5, el IMC≥28,5kg/m2, el antecedente de diabetes mellitus en familiares de primer y la gestación múltiple son factores que se asocian con alto riesgo de desarrollar DG; estos factores serían suficientes para identificar a la mayoría de las gestantes que desarrollarán DG. Nuestros resultados pueden aplicarse para mejorar los programas de atención prenatal destinados al diagnóstico y tratamiento precoz de la DG.(au)

Objectives: The main objective is to determine the current prevalence of recognised risk factors for gestational diabetes mellitus (GDM) in our region, and to define the profile of patients at higher risk of developing this condition. We also investigate patient acceptability of the screening tests. Material and methods: This is an ambispective study with 1,448 pregnant women recruited between December 2017 and July 2019 from a single centre. Inclusion criteria were no diabetes mellitus prior to the pregnancy, no history of GDM in any previous pregnancy, no history of bariatric surgery before the pregnancy, and GDM screening tests performed. Results: The prevalence of GDM was 6.7%. Risk factors associated with development of GDM were: age≥27.5 years (OR: 3.8; 95% CI: 2.01-9.16); BMI≥28.5kg/m2 (OR: 2.3; 95% CI: 1.47-3.59); history of diabetes mellitus in first-degree relatives (OR: 2.3; 95% CI: 1.5-3.66); and multiple pregnancy (OR: 2.8; 95% CI: 0.86-6.36); Prevalence of GDM increased with the number of risk factors presented by patients: from 1.4% with no risk factor, to 25.2% with 3. The O'Sullivan test (50g glucose) and oral glucose tolerance test (100g glucose) were perceived as “unpleasant” by 26.8% and 65.4% of patients, respectively. Conclusions: Age≥27.5 years, BMI≥28.5kg/m2, history of diabetes mellitus in first-degree relatives, and multiple pregnancy are factors related to an increased risk of GDM; these factors would be enough to identify most pregnant women developing GDM. Our findings may be used to improve programmes aimed at early diagnosis of gestational diabetes and supporting high-risk mothers in antenatal care.(AU)

Valores extremos del IMC materno: factores determinantes de peores resultados obstétricos y perinatales / Extreme values of maternal BMI: Determinants of worse obstetric and perinatal outcomes

Objetivo: Conocer la influencia del índice de masa corporal (IMC) materno al inicio del embarazo en los resultados obstétricos-perinatales. Material y métodos: Estudio observacional-ambispectivo. Se incluyeron 1.407 pacientes con gestaciones únicas y partos de fetos>24 semanas entre el 01/12/2017 y el 31/07/2019. La muestra fue estratificada según su IMC según la clasificación de la OMS. Se analizaron variables sobre: enfermedad pregestacional, gestacional, asistencia obstétrica y resultados maternos-perinatales y se compararon entre los grupos estudiados. El programa estadístico utilizado ha sido R Core Team 2020, versión 3.6.3. Un valor de p≤0,05 se consideró significativo. Resultados: Las obesas ii-iii (IMC 35-39 e IMC≥40, respectivamente) tienen mayor riesgo de hipertensión arterial crónica (OR 53,54, IC95% 18,21-229,02), diabetes gestacional (OR 5,24, IC95% 2,87-9,51) y preeclampsia (OR 2,38, IC95% 0,95-5,51; p=0,049). Las de bajo peso tuvieron más fetos con crecimiento intrauterino restringido (OR 3,09, IC95% 1,46-6,17). Las inducciones del parto y las cesáreas aumentan conforme lo hace el IMC (p=0,006). Las pacientes con bajo peso también tuvieron mayor riesgo de cesárea (OR 2,46, IC95% 1,06-5,20). Los ingresos neonatales fueron más frecuentes en mujeres obesas y con bajo peso (OR 2,68, IC95% 1,39-5,00, y OR 2,56, IC95% 1,10-5,44, respectivamente). Las obesas tuvieron más riesgo de peso neonatal>4.000g (OR 3,06, IC95% 1,57-5,77) y las gestantes de bajo peso más riesgo de peso neonatal<2.500g (OR 2,94, IC95% 1,54-5,41). Conclusión: Los valores extremos del IMC materno al inicio de la gestación son factores determinantes para un desenlace obstétrico-perinatal adverso.(AU)

Objective: To study the influence of maternal body mass index (BMI) at the beginning of pregnancy on obstetric-perinatal outcomes. Material and methods: Observational-ambispective study. We recruited 1407 patients with singleton gestations and deliveries of foetuses>24 weeks between 01/12/2017 and 31/07/2019. The sample was stratified according to their BMI following the WHO classification. Variables on pre-pregnancy, gestational disease, obstetric care, and maternal-perinatal outcomes were analysed and compared between the studied groups. The statistical program has been R Core Team 2020, version 3.6.3. P≤.05 was considered significant. Results: Class II-III (BMI 35-39 and BMI≥40 respectively) obese women have a higher risk of chronic arterial hypertension (OR 53.54, 95% CI 18.21-229.02), gestational diabetes (OR 5.24, 95% CI 2.87-9.51) and preeclampsia (OR 2.38, 95% CI 0.95-5.51 with P=.049). The underweight women had more intrauterine growth restriction diagnoses (OR 3.09, 95% CI 1.46-6.17). Inductions of labour and caesarean sections increase as BMI increases (P=.006). Low weight patients also had a higher risk of caesarean section (OR 2.46, 95% CI 1.06-5.20). Neonatal admissions were more frequent in obese and underweight women (OR 2.68, 95% CI 1.39-5.00 and OR 2.56, 95% CI 1.10-5.44 respectively). Obese women had a higher risk of neonatal weight>4000g (OR 3.06, 95% CI 1.57-5.77) and low weight pregnant women had a higher risk of neonatal weight<2500g (OR 2.94, 95% CI 1.54-5.41). Conclusion: Extreme values of maternal BMI at the beginning of gestation are determining factors for an adverse obstetric-perinatal outcome.(AU)

Capacity Building in Sub-Saharan Africa as Part of the INTENSE-TBM Project During the COVID-19 Pandemic.

Tuberculous meningitis (TBM) is the most severe and disabling form of tuberculosis (TB), with at least 100,000 cases per year and a mortality rate of up to 50% in individuals co-infected with human immunodeficiency virus type 1 (HIV-1). To evaluate the efficacy and safety of an intensified anti-tubercular regimen and an anti-inflammatory treatment, the INTENSE-TBM project includes a phase III randomised clinical trial (TBM-RCT) in four countries in sub-Saharan Africa (SSA). Within this framework, we designed a comprehensive capacity-building work package ensuring all centres had, or would acquire, the ability to conduct the TBM-RCT and developing a network of skilled researchers, clinical centres and microbiology laboratories. Here, we describe these activities, identify strengths/challenges and share tools adaptable to other projects, particularly in low- and lower-middle income countries with heterogeneous settings and during the coronavirus disease 2019 (COVID-19) pandemic. Despite major challenges, TBM-RCT initiation was achieved in all sites, promoting enhanced local healthcare systems and encouraging further clinical research in SSA. In terms of certified trainings, the achievement levels were 95% (124/131) for good clinical practice, 91% (39/43) for good clinical laboratory practice and 91% (48/53) for infection prevention and control. Platform-based research, developed as part of capacity-building activities for specific projects, may be a valuable tool in fighting future infectious diseases and in developing high-level research in Africa.

The INTENSE-TBM project aimed to design a comprehensive work-package on capacity building, ensuring all centres would acquire the ability to conduct a phase III randomised clinical trial on TBM in sub-Saharan Africa, to reduce tuberculous meningitis mortality and morbidity in patients with/without HIV-1 co-infection. Therefore, the INTENSE-TBM project is an example of how an international clinical research consortium can provide opportunities to enhance local capacity building and promote centres without previous experience in clinical research. This article provides practical approaches for implementing effective capacity-building programmes. We highlight how to overcome limitations imposed by the COVID-19 pandemic to successfully complete clinics, laboratory set-ups and personnel training, so as to optimise resources and empower African institutions on a local level. At the same time, our experience shows how capacity-building programmes can deliver long-lasting impact that extends beyond the original aims of the project (e.g. HIV and TB), and support local health systems in fighting other infectious disease (e.g. COVID-19). Research projects in low- and lower-middle income countries with heterogeneous settings could stand to benefit the most.

Visualization of Fast Ion Phase-Space Flow Driven by Alfvén Instabilities.

Fast ion phase-space flow, driven by Alfvén eigenmodes (AEs), is measured by an imaging neutral particle analyzer in the DIII-D tokamak. The flow firstly appears near the minimum safety factor at the injection energy of neutral beams, and then moves radially inward and outward by gaining and losing energy, respectively. The flow trajectories in phase space align well with the intersection lines of the constant magnetic moment surfaces and constant E-(ω/n)P_{ζ} surfaces, where E, P_{ζ} are the energy and canonical toroidal momentum of ions; ω and n are angular frequencies and toroidal mode numbers of AEs. It is found that the flow is so destructive that the thermalization of fast ions is no longer observed in regions of strong interaction. The measured phase-space flow is consistent with nonlinear hybrid kinetic-magnetohydrodynamics simulation. Calculations of the relatively narrow phase-space islands reveal that fast ions must transition between different flow trajectories to experience large-scale phase-space transport.

Retrospective diagnosis of lymphatic tuberculosis in frozen samples using two genetic amplification methods, Xpert® MTB/RIF ULTRA and Abbott RealTime MTB Assay.

OBJECTIVE: The main objective of the present study is to assess the sensitivity and specificity of a retrospective diagnostic of lymphatic tuberculosis (LTB), testing frozen samples using gene amplification PCR methods. The secondary objective was to compare the results of two different commercial tuberculosis gene amplification methods for this purpose. METHODS: We retrospectively studied 38 frozen samples, previously processed for mycobacterial culture between January 2014 and August 2019. The results of the previous cultures were: 21 samples positive for Mycobacterium tuberculosis complex (MTB) (5 being smear positive), 7 samples culture positive for Mycobacterium avium-intracellulare complex and 10 samples which were mycobacterial culture negative and discarded for LTB diagnosis, used as controls. The samples were processed using two gene amplification methods: Xpert® MTB/RIF Ultra (Cepheid) and Abbott RealTime MTB Assay (Abbott). RESULTS: Compared to initial culture results the sensitivity and specificity of Xpert® MTB/RIF Ultra were 57.1% and 100% and 52.3 % and 92.5%, respectively for the Abbott RealTime MTB assay. The differences were not statiscally significant. In addition, there were no differences according to the period of freezing. CONCLUSIONS: Gene amplification of frozen samples confirmed the diagnosis of lymphatic TB in almost 60% of cases, allowing retrospective diagnosis in initially non suspected cases. Both gene amplification techniques tested were equally useful.

Efficacy and safety of intermittent repeated levosimendan infusions in advanced heart failure patients: the LAICA study.

AIMS: The aim of the LAICA study was to evaluate the long-term effectiveness and safety of intermittent levosimendan infusion in patients with advanced heart failure (AdHF). METHODS AND RESULTS: This was a multicentre, randomized, double-blind, placebo-controlled clinical trial of intermittent levosimendan 0.1 µg/kg/min as a continuous 24-h intravenous infusion administered once monthly for 1 year in patients with AdHF. The primary endpoint [incidence of rehospitalization (admission to the emergency department or hospital ward for >12 h) for acute decompensated HF or clinical deterioration of the underlying HF] occurred in 23/70 (33%) of the levosimendan group (Group I) and 12/27 (44%) of the placebo group (Group II) (P = 0.286). The incidence of hospital readmissions for acute decompensated HF (Group I vs. Group II) at 1, 3, 6, and 12 months was 4.2% vs. 18.2% (P = 0.036); 12.8% vs. 33.3% (P = 0.02); 25.7% vs. 40.7% (P = 0.147); 32.8% vs. 44.4% (P = 0.28), respectively. In a secondary pre-specified time-to-event analysis no differences were observed in admission for acute decompensated HF between patients treated with levosimendan compared with placebo (hazard ratio 0.66; 95% CI, 0.32-1.32; P = 0.24). Cumulative incidence for the aggregated endpoint of acute decompensation of HF and/or death at 1 and 3 months were significatively lower in the levosimendan group than in placebo group [5.7% vs. 25.9% (P = 0.004) and 17.1% vs. 48.1% (P = 0.001), respectively], but not at 6 and 12 months [34.2% vs. 59.2% (P = 0.025); 41.4% vs. 66.6% (P = 0.022), respectively]. Survival probability was significantly higher in patients who received levosimendan compared with those who received placebo (log rank: 4.06; P = 0.044). There were no clinically relevant differences in tolerability between levosimendan and placebo and no new safety signals were observed. CONCLUSIONS: In our study, intermittent levosimendan in patients with AdHF produced a statistically non-significant reduction in the incidence of hospital readmissions for acute decompensated HF, a significantly lower cumulative incidence of acute decompensation of HF and/or death at 1 and 3 month of treatment and a significant improvement in survival during 12 months of treatment.

Self-adaptive diagnostic of radial fast-ion loss measurements on the ASDEX Upgrade tokamak (invited).

A poloidal array of scintillator-based Fast-Ion Loss Detectors (FILDs) has been installed in the ASDEX Upgrade (AUG) tokamak. While all AUG FILD systems are mounted on reciprocating arms driven externally by servomotors, the reciprocating system of the FILD probe located just below the midplane is based on a magnetic coil that is energized in real-time by the AUG discharge control system. This novel reciprocating system allows, for the first time, real-time control of the FILD position including infrared measurements of its probe head temperature to avoid overheating. This considerably expands the diagnostic operational window, enabling unprecedented radial measurements of fast-ion losses. Fast collimator-slit sweeping (up to 0.2 mm/ms) is used to obtain radially resolved velocity-space measurements along 8 cm within the scrape-off layer. This provides a direct evaluation of the neutral beam deposition profiles via first-orbit losses. Moreover, the light-ion beam probe (LIBP) technique is used to infer radial profiles of fast-ion orbit deflection. This radial-LIBP technique is applied to trapped orbits (exploring both the plasma core and the FILD stroke near the wall), enabling radial localization of internal plasma fluctuations (neoclassical tearing modes). This is quantitatively compared against electron cyclotron emission measurements, showing excellent agreement. For the first time, radial profiles of fast-ion losses in MHD quiescent plasmas as well as in the presence of magnetic islands and edge localized modes are presented.

Implementation of synthetic fast-ion loss detector and imaging heavy ion beam probe diagnostics in the 3D hybrid kinetic-MHD code MEGA.

A synthetic fast-ion loss (FIL) detector and an imaging Heavy Ion Beam Probe (i-HIBP) have been implemented in the 3D hybrid kinetic-magnetohydrodynamic code MEGA. First synthetic measurements from these two diagnostics have been obtained for neutral beam injection-driven Alfvén Eigenmode (AE) simulated with MEGA. The synthetic FILs show a strong correlation with the AE amplitude. This correlation is observed in the phase-space, represented in coordinates (Pϕ, E), being toroidal canonical momentum and energy, respectively. FILs and the energy exchange diagrams of the confined population are connected with lines of constant E', a linear combination of E and Pϕ. First i-HIBP synthetic signals also have been computed for the simulated AE, showing displacements in the strike line of the order of ∼1 mm, above the expected resolution in the i-HIBP scintillator of ∼100 µm.

Probiotic Properties of Alcaligenes faecalis Isolated from Argyrosomus regius in Experimental Peritonitis (Rat Model).

A strain of Alcaligenes faecalis A12C (A. faecalis A12C) isolated from Argyrosomus regius is a probiotic in fish. Previous experiments showed that A. faecalis A12C had inhibitory effects on the growth of multidrug-resistant bacteria. We aimed to confirm whether A. faecalis A12C is safe and has adequate intestinal colonization in experimental rats, and evaluate its efficacy in an animal model of peritonitis. We used 30 male rats, randomly divided into 6 groups (n = 5): three groups (HA7, HA15, HA30) received A. faecalis A12C in drinking water (6 × 108 CFU/mL) for 7 days, and three control groups received drinking water only. All groups were evaluated at 7, 15, and 30 days. Survival after A. faecalis A12C administration was 100% in all groups. Mild eosinophilia (1.5%, p < 0.01) and increased aspartate aminotransferase (86 IU/L, p < 0.05) were observed in HA7, followed by progressive normalization. No histological signs of organ injury were found. We observed significant E. coli decline in faeces, parallel to an increase in A. faecalis A12C at 7 days. E. coli had a tendency to recover initial values, while A. faecalis A12C disappeared from the intestinal microbiota at 30 days. To evaluate its efficacy against peritonitis, we studied two additional groups of animals: IA group pretreated with A. faecalis A12C before E. coli intra-abdominal inoculation, and IC group inoculated with no A. faecalis A12C. We found an increase in C-reactive protein, alanine aminotransferase, urea, and eosinophils in IC animals when compared with IA. Peritonitis was more evident in IC than in IA animals. Our findings suggest that A. faecalis A12C altered clinically relevant parameters in sepsis and was associated with a lesser spread of infection.

An investigation into the development of right displaced abomasum by rolling 268 dairy cows with left displaced abomasum.

Right displaced abomasum (RDA) and abomasal volvulus (AV) are common diseases in cattle. However, presently there is no consensus regarding the pathogenesis and nomenclature of the different positions that the abomasum can adopt in the right side of the cow. Therefore, the objective of this study was to describe the etiopathogenesis of the right displaced abomasum according to the description of the features observed in 268 cows with left displaced abomasum (LDA), which were rolled to induce the movement of the abomasum from the left side to the right (in fact, inducing an RDA in 44% of cases), to facilitate the surgical approach, and immediately surgically treated (abomasal omentopexy from the right side). The observed RDA positions matched previously published descriptions and names, and the authors propose a holistic and simpler nomenclature and a clear hypothesis on RDA etiopathogenesis. In 54.1% of the cases, the abomasum moved to a normal position after rolling. The most common RDA position observed was caudal displacement of the RDA (CdRDA; 70 out of 119 RDA cases; 26.1% of the total number of cows), followed by lateral displacement (LRDA; 32 of 119; 11.9% of all cases), cranial displacement (CrRDA; 8 of 119; 3% of the total), medial displacement (MRDA; 4 of 119; 1.5% of the total), and finally, displacement lateral to the omasum (LORDA; 3 of 119; 1.1% of the total). Adverse events directly due to the rolling procedure were mesenteric root volvulus (3 of 268), cecocolic volvulus (2 of 268) and torsion (1 of 268), and uterus torsion (2 of 10 pregnant cows); 1 abortion (1 of 10 pregnant cows) was also observed. We suggest that CdRDA is the first stage of an RDA that can become an LRDA with increasing pressure. An LRDA can become an AV if rotating counterclockwise, viewed from above. An LDA, CdRDA, or LRDA could be initial forms of LORDA and CrRDA, and occur when forestomachs are empty or when the animal stands up on its front legs first. The LORDA and CrRDA forms can lead to an omasum-abomasum volvulus (OAV) or to a reticulum-omasum-abomasum volvulus (ROAV) when pressure increases. With this study we establish, for the first time, the sequence and incidence of each RDA form and its complications, increasing knowledge of this syndrome and its pathogenesis. This understanding critically aids the surgeon's ability to accurately assess and correct this disease and to predict prognosis.

Long-Term Radiotherapy-Induced Cardiac Complications: A Case Report.

BACKGROUND Tumor disease has improved survival due to therapeutic advances and early diagnosis. However, anti-neoplastic treatment involves generating harmful side effects in the body, both in the short-term and in the long-term. One of the most important side effects is cardiovascular disease after radiotherapy, which in addition to being influenced by classic cardiovascular risk factors, can be also be influenced by anti-neoplastic therapy, and represents the main cause of death after a second cancer. We present a case that synthesizes the most relevant and determining aspects of radiotherapy-induced heart disease. CASE REPORT We present the case of a 48-year-old male with a personal history of mediastinal Hodgkin lymphoma who was treated with local radiotherapy 20 years ago, and who was admitted to hospital due to dyspnea and oppressive chest pain with efforts. He was diagnosed with severe aortic stenosis, and a coronary angiography confirmed the existence of coronary disease. Two years before, he had been admitted to hospital due to syncope and a pacemaker had been implanted. This patient experienced several cardiovascular complications that could be attributed to the radiotherapy treatment received in his past. CONCLUSIONS Radiotherapy shows multiple cardiological complications, especially when applied at the thoracic level. This fact is very relevant, and this report can help determine the aspects of radiotherapy-induced heart disease affecting the mortality and morbidity of these patients.

Concordancia radio-histológica en meningiomas intracraneales / Radio-histological concordance in intracranial meningiomas

INTRODUCCIÓN: los meningiomas suponen el 15-20% de las neoformaciones primarias del SNC en adultos. La mayoría son benignos, encontrando únicamente un 5% de tumores malignos. La RM los caracteriza pero el diagnóstico definitivo se confirma mediante histopatología. OBJETIVOS: determinar si la agresividad de los meningiomas intracraneales utilizando la RM es congruente con la agresividad que se demuestra en el estudio histopatológico. MATERIAL Y MÉTODO: se estudian 14 casos de meningiomas intracraneales con imagen de RM y estudio histopatológico comprendidos entre los años 2004 y 2016. Se analizan sus características radiológicas determinando su agresividad mediante RM e histopatología. RESULTADOS: 7 (50%) de los 14 meningiomas fueron agresivos en el estudio mediante RM, mientras que 4 (28,6%) lo hicieron mediante el estudio histopatológico. La sensibilidad de la RM fue del 100% y la especificidad 70%. Las únicas variables que consiguieron una p < 0,05 en el estudio de agresividad mediante RM fueron los márgenes irregulares y el realce heterogéneo. CONCLUSIONES: La RM es apta para su utilización como técnica de cribado inicial en el diagnóstico de agresividad de meningiomas intracraneales, siendo limitada para su diagnóstico confirmatorio. No se han encontrado evidencias significativas para determinar qué características radiológicas definen la agresividad tumoral

AIM: meningiomas account for 15-20% Central Nervous System primary neoplasms in adults. Many are benign, but the 5% of them are malignant. MRI characterizes them, describing a series of radiological findings suggestive of aggressiveness, although the diagnosis is confirmed by histopathology. OBJECTIVES: Determine if the aggressiveness of intracranial meningiomas using MRI is consistent with histopathology. Material and METHODOLOGY: 14 cases of meningiomas with MR imaging and histopathology ranging 2004 to 2016 were reported. Its radiological characteristics were analyzed by determining their aggressiveness by MRI and Histopathology, carried out a study of diagnostic tests. RESULTS: 7 (50%) of the 14 meningiomas were aggressive in the study by MRI, while 4 (28.6%) did so by histopathology. The sensibility of MRI was 100% and specificity 70%. The only variables that achieved p < 0.05 by studying aggression MRI were irregular borders and heterogeneous enhancement. CONCLUSIONS: MRI is suitable for use as initial screening in the diagnosis of intracranial meningiomas aggressiveness, being restricted for confirmatory diagnosis. We found no significant evidence to determine what radiological characteristics define tumor aggressiveness