Real-life clinical practice in Spain in the setting of new drug availability for ITP treatment. A Delphi-based Spanish expert panel consensus.

Immune thrombocytopenia (ITP) is a common autoimmune hematological disorder. Despite this, diagnosis is still challenging due to clinical heterogeneity and the lack of a specific diagnostic test. New findings in the pathology and the availability of new drugs have led to the development of different guidelines worldwide. In the present study, the Delphi methodology has been used to get a consensus on the management of adult patients with ITP in Spain and to help in decision-making. The Delphi questionnaire has been designed by a scientific ad hoc committee and has been divided into 13 topics, with a total of 127 items, covering the maximum possible scenarios for the management of ITP. As a result of the study, a total consensus of 81% has been reached. It is concluded that this Delphi consensus provides practical recommendations on topics related to diagnosis and management of ITP patients to help doctors to improve outcomes. Some aspects remain unclear, without consensus among the experts. Thus, more advances are needed to optimize ITP management.

What is the context? Immune thrombocytopenia (ITP) is a hematologic autoimmune disease characterized by accelerated destruction and inadequate production of platelets mediated by autoantibodies (platelet count <100 × 10⁹ /L).Despite being a common condition, its heterogeneous clinical course makes its diagnosis and management still a challenge.In recent years, new molecules with different mechanisms of action have emerged for the treatment of ITP.Due to the increasing information about the pathology and its therapies, several international guidelines have recently been established to provide recommendations for the management and treatment of ITP.There are still many patient scenarios and disease aspects which are not addressed in the guidelines.What is new? Our Spanish ITP Expert Group has developed a Delphi consensus study to provide recommendations and promote standardization of the management of adult patients with ITP in Spain.The scientific committee defined 127 statements for consensus, corresponding to 13 chapters: (i) Diagnosis of ITP, (ii) First-line treatment, (iii) Second-line treatment, (iv) Treatment of refractory patients, (v) Follow-up, (vi) Emergency and surgery, (vii) ITP in the elderly, (viii) ITP in pregnancy, (ix) Anticoagulation and antiplatelet, (x) Secondary ITP, (xi) Quality of life, (xii) Discontinuation of TPO-RA, and (xiii) ITP and Covid.The total number of agreed statements achieved was 103, giving a final percentage of consensus in the Delphi questionnaire of 81%.What is the impact? This Delphi consensus provides recommendations based on real clinical practice data, regarding the diagnosis, treatment, and management of patients and scenarios in ITP to assist clinicians in addressing this disease and achieving optimal outcomes for the patient.

Impact of natural events on metal bioaccumulation in Anemonia sulcata.

Samples of Anemonia sulcata were collected in 2022 from different areas of the Canary Islands affected by different natural contamination sources, such sandstorms, submarine volcanic activity, continuous rainfall, upwelling and dinoflagellate blooms. Significant differences were observed between the zones for the metals and trace elements analyzed (Al, Zn, Cd, Pb, Ni, Co, Fe, B, Cu, Mg and Li). Anemones from volcanic areas showed higher levels of Cd, Pb and Ni. Individuals from sandstorm areas showed elevated levels of Al, Zn and Fe. Samples collected from areas affected by upwelling processes had higher concentrations of Cu, Mg and Li. Finally, the areas affected by dinoflagellates showed lower levels of Zn, Pb, Fe, Mg and Li. The study reveals how natural phenomena dramatically influence metal accumulation in A. sulcata, which is of great value for anticipating and managing potential problems associated with public health.

Interplay of the Mediterranean diet and genetic hypertension risk on blood pressure in European adolescents: Findings from the HELENA study.

Early-life onset of high blood pressure is associated with the development of cardiovascular diseases in adulthood. In adolescents, limited evidence exists regarding the association between adherence to the Mediterranean Diet (MedDiet) and normal blood pressure (BP) levels, as well as its potential to modulate genetic predisposition to HTN. This study investigated the interaction between a MedDiet score and a recently developed HTN-genetic risk score (HTN-GRS) on blood pressure levels in a European adolescent cohort. The MedDiet score was derived from two non-consecutive 24-h dietary recalls and ranged from 0 (indicating low adherence) to 9 (indicating high adherence). Multiple linear regression models, adjusted for covariates, were employed to examine the relationship between the MedDiet score and BP z-scores and to assess the interaction effects between the MedDiet score and HTN-GRS on BP z-scores. MedDiet score showed a negative association with z-systolic BP (SBP) (ß = -0.40, p < 0.001) and z-diastolic BP (DBP) (ß = -0.29, p = 0.001). Additionally, a significant interaction effect was identified between the MedDiet score and HTN-GRS on z-SBP (ß = 0.02, p < 0.001) and z-DBP (ß = 0.02, p < 0.001). The modulatory effect of the MedDiet was more pronounced in females than in males, and HTN-GRS exhibited a stronger influence on DBP than on SBP.   Conclusion: The study suggests that higher adherence to the MedDiet is associated with reduced BP levels in adolescents and provides evidence of a genetic-diet interaction influencing BP in adolescents. What is Known: • Adherence to the Mediterranean diet may reduce BP levels. What is New: • It is the first study to assess the connection between adherence to a Mediterranean diet, a hypertension genetic risk score, and how they interact in influencing blood pressure. • It is conducted within a multicenter cohort of European adolescents.

Comparative analysis of metal pollution in the Atlantic Ocean and Mediterranean Sea: insights from Anemonia sulcata study.

In this study, we investigated metal concentrations in Anemonia sulcata specimens from various locations in the Atlantic Ocean and the Mediterranean Sea. A total of 84 individuals were sampled from specific zones, and their tissue samples were processed for metal analysis using Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES). The results revealed notable differences in metal concentrations among the studied regions. The Atlantic Ocean and the Mediterranean Sea were found to have distinct patterns of marine pollution, influenced by a complex interplay of geographical, demographic, industrial, and environmental policy factors. Conversely, the semi-enclosed Mediterranean Sea has a lower natural dilution capacity, leading to the accumulation and prolonged presence of pollutants. Population density and industrial activities in coastal areas play a significant role in pollution disparities between the Mediterranean Sea and the Atlantic Ocean. The Mediterranean coasts, with higher population densities and intensive industrial operations, experience greater strain on marine ecosystems due to increased pollution sources. Additionally, environmental policies and management approaches differ between the two regions, contributing to variations in pollution response and regulation.

Metal content in Sardina pilchardus during the period 2014-2022 in the Canary Islands (Atlantic EC, Spain).

The contamination present in an organism varies depending on biological and oceanographic conditions, so monitoring the same species is of great importance to understand the state of the ecosystem. Fifteen specimens in Sardina pilchardus between 12 and 15 cm in total length were collected during the second half of January of each of the study years (2014, 2016, 2018, 2020 and 2022). Samples were analyzed with Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES) to measure metals (Al, Cd, Cu, Fe, Li, Ni, Pb and Zn) in mg/Kg. There was a progressive decrease in Pb content over the period, with the highest concentration being obtained in 2014 (0.086 ± 0.065 mg/kg). Locally important oceanic-atmospheric events may occur in the study period that strongly impact the tissue composition of marine organisms. In this case, discontinuous trends were evident in some of the metal concentrations analyzed in the muscle of European sardine in the Canary Islands.

A Comparative Analysis of Sparisoma cretense in Island Environments: Unraveling Metal Accumulation Differences in the Canary Islands (Spain, NW African Waters).

This study investigates the impact of varying environmental conditions on the metal composition within the tissues of Sparisoma cretense, contributing to the understanding necessary to offer scientifically sound advice regarding the health status of this species. This knowledge extends beyond fishery production, encompassing implications for food security. The data span the years 2022 and 2023, encompassing both cold and warm climatic seasons. The concentrations of various metals, such as Al, Zn, Cd, Pb, Fe, and Cu, exhibited noteworthy variations across the islands, with significant increases recorded in 2023, particularly during the warm season. The intricate interplay between multiple factors shaped the availability of the analyzed elements in S. cretense. Factors such as rising temperatures during the warm season increased biological activity in marine ecosystems, seasonal fluctuations in weather conditions, water quality, and anthropogenic influences, all contributing to the observed variations in metal concentrations. Additionally, the geological composition of each island and the patterns of marine currents and sediment transport play pivotal roles in these differences. Comprehensive scientific research, monitoring, and environmental surveillance are essential for a holistic understanding of this variability and providing valuable insights for the conservation and management of marine ecosystems in the Canary archipelago.

Soft Drinks as a Dietary Source of Fluoride Exposure.

High fluoride exposures can lead to adverse effects such as dental and bone fluorosis, as well as endocrine and cognitive developmental problems. Water is the main dietary source of this ion, although significant concentrations have also been detected in other beverages widely consumed by the population such as soft drinks. A total of 200 soft drink samples (60 flavoured, 70 extracts, 60 fruit juice and 10 soft drinks) were analysed by fluoride ion selective potentiometry. A consumption of 330 mL was estimated for exposure assessment and subsequent F-risk assessment by soft drink consumption. The highest average concentration was found in extract soft drinks (2.45 ± 1.15 mg/L), followed by flavoured (1.71 ± 2.29 mg/L) and carbonated soft drinks (1.38 ± 0.40 mg/L), while the lowest was found in fruit juice soft drinks (1.09 ± 0.62 mg/L). The flavours with the highest concentration were tea-melon and tea-passion fruit with 3.66 ± 0.40 and 3.17 ± 0.56 mg/L respectively and the lowest was lemon flavour with 0.69 mg/L. The contribution of these beverages, considering the UL (Upper level) reference values set by EFSA (European Food Safety Authority) are between 3.28-41.78%, depending on age group and sex.

Impact of the lockdown period during the COVID-19 pandemic on the metal content of the anemone Anemonia sulcata in the Canary Islands (CE Atlantic, Spain).

Anemones, specifically the species Anemonia sulcata, are cnidarians that serve as bioindicators in marine ecosystems, indicating the health of the environment and changes in environmental conditions. Monitoring anemone populations and studying their well-being and distribution provide valuable insights into marine ecosystem conditions. This study aimed to investigate the impact of the SARS-CoV-2 pandemic on the metal content of Anemonia sulcata. Over a six-year period (2017-2022), twenty specimens of Anemonia sulcata were collected in Tenerife, Spain. The results showed that in 2020, during the two-month lockdown in Spain from March to May when tourism was halted, A. sulcata exhibited the lowest concentrations of various metals studied (Al, Cd, Cu, Fe, Pb, and Zn). This finding suggests that the reduced anthropogenic pressure on the coast due to the absence of tourism significantly decreased pollution levels. Therefore, the study emphasizes the importance of promoting sustainable tourism worldwide. The research highlights that minimizing human impact on coastal areas through responsible tourism practices can effectively reduce pollution in marine ecosystems.

Assessment of coagulation assays on Roche Cobas t711 analyzer: performance and clinical implications.

OBJECTIVES: We performed an analytical assessment of five coagulation tests [i.e. prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, thrombin time (TT) and D-dimer] on the Roche Cobas t711 analyzer and a comparison study with the methodology in use at our laboratory (i.e. Werfen ACL Top 750 analyzer), expanding the analysis to the clinical implications of Cobas t711 implementation. METHODS: Imprecision studies were performed following the Clinical and Laboratory Standards Institute (CLSI) H57 A:2008 guideline. Linearity of D-dimer and fibrinogen tests was analysed according to the CLSI EP06-A: 2003 recommendations. For method comparison, the results were analyzed using the Bland-Altman plot and Passing-Bablok regression. RESULTS: Imprecision met manufacturer claims for PT, aPTT and TT. D-dimer and fibrinogen tests showed a coefficient of variation (CV)% over manufacturer claims at certain concentration levels. Linearity ranges could not be verified. Comparison study revealed that results are not interchangeable for any test, a lower correlation for aPTT test and lower D-dimer results from Roche Cobas t711. CONCLUSION: The strength of this study relies on the analysis of the clinical implications of reporting Cobas t711 results compared to those obtained with the methodology in use at our laboratory. Different sensibility to factor deficiency, anticoagulant therapy and interferences might explain lower correlation rates obtained for the aPTT test. Different monoclonal antibodies used for D-dimer determination might explain the lower results obtained with the Cobas t711 analyzer. This aspect needs further studies given the relevance of D-dimer test to exclude thrombotic events and reinforces the need of harmonization in the haemostasis laboratory.

Recommendations for the Clinical Approach to Immune Thrombocytopenia: Spanish ITP Working Group (GEPTI).

Primary immune thrombocytopenia (ITP) is a complex autoimmune disease whose hallmark is a deregulation of cellular and humoral immunity leading to increased destruction and reduced production of platelets. The heterogeneity of presentation and clinical course hampers personalized approaches for diagnosis and management. In 2021, the Spanish ITP Group (GEPTI) of the Spanish Society of Hematology and Hemotherapy (SEHH) updated a consensus document that had been launched in 2011. The updated guidelines have been the reference for the diagnosis and management of primary ITP in Spain ever since. Nevertheless, the emergence of new tools and strategies makes it advisable to review them again. For this reason, we have updated the main recommendations appropriately. Our aim is to provide a practical tool to facilitate the integral management of all aspects of primary ITP management.

Contributions of one hypothetical model of predictive relationships between psychological skills and emotional intelligence in university student-athletes: A cross-sectional study.

Psychological skills are considered in sport psychology as indispensable capabilities to analyze the athlete's own vision of his or her own personality. These skills encompass self-confidence, positive and negative coping control, attentional control, visual-imaginative control, motivational level, and attitudinal control. The significance of this research lies in demonstrating the relationship established between each of the dimensions of emotional intelligence and the constituent skills of the personality. As such, this study aims to investigate the relationship between the seven factors related to psychological skills and emotional intelligence (attention, clarity, and emotional regulation). The sample comprises 163 university students pursuing degrees in Physical Activity and Sports Sciences, [70,9% (N = 117) men and 27.9% (N = 46) women] with a mean age of 20.33 years. As assessment instruments, we used two validated and standardized scales, the IPED and the TMMS-24. The main findings of this work allow us to affirm the existence of a relationship between the three dimensions of emotional intelligence and the control of both positive and negative coping, attentional control, visual-imaginative control, motivational level, and attitudinal control. In conclusion, this study underscores the necessity of cognitive and emotional training, in addition to physical training, to enhance these skills among both male and female athletes.

Monitoring different sources of marine pollution in the Canarian intertidal zone using Anemonia sulcata as a bioindicator.

Sea anemones have often been used as bioindicators of contamination because they are semisessile organisms that rarelly leave their niche, which is why they are conducive to affecting the ecosystem at the local level. The objective of this work is to determine whether the concentrations of heavy metals and trace elements in the anemone Anemonia sulcata vary depending on the source of contamination present. In 2021 seventy specimens were collected at five sampling points and fourteen specimens were collected in each point (Control Zone, Thermal Power Plant, Sewage Pipe, Harbour and Tourism) in 2021, on the island of Tenerife. All the areas studied characterized by a pollution condition had higher concentrations of metals and trace elements than the control area. The anemones from Harbour presented a greater number of metals with a higher concentration than the other study areas.

Assessment of potential risks to human health associated with trace elements in three commercially important shark species captured in the Central Mexican Pacific.

Shark meat is a popular protein source worldwide. However, existing national control policies for ensuring the safety and quality of shark meat are minimal. There are concerns about the sustainability of shark populations, which bioaccumulate and biomagnify potentially toxic elements at higher rates than non-predatory fish, posing a risk to human health. In this study, the contributions of essential elements to the Recommended Dietary Allowance (RDA) and potentially toxic elements to the Reference Dose (RfD) linked to shark consumption (200 g per week) were investigated for three shark species in the Central Mexican Pacific. We estimated risks and benefits for women, children, and men. Our results suggest that the three shark species are sources of Se, Co, Cr, Cu, Fe, and Zn, but poor sources of Mn for women and men aged 19-50 years. A weekly ingestion of 200 g of shark meat exceeded the RfD-As by 4-14 times and the RfD-Pb by 1.1-1.7 times for adults, indicating a potential risk to human health. The three shark species were also significant sources of potentially toxic elements for children, including Hg, Cd, Cr, and Pb. An excessive intake of Se was observed, with levels at 8.4-10.6 and 4.3-5.3 times the RDA for children aged 1-8 and 9-13 years, respectively. Although shark meat can be a good source of essential nutrients, the lack of controls in the commercialization process indicates that it should be consumed in moderation due to the potential risks associated with excessive exposure to potentially toxic elements. This caution is particularly important for children and pregnant women, who are at higher risk of health complications from consuming contaminated food.

Neuroprotective effects of hepatoma-derived growth factor in models of Huntington's disease.

Huntington's disease (HD) is a movement disorder caused by a mutation in the Huntingtin gene that leads to severe neurodegeneration. Molecular mechanisms of HD are not sufficiently understood, and no cure is currently available. Here, we demonstrate neuroprotective effects of hepatoma-derived growth factor (HDGF) in cellular and mouse HD models. We show that HD-vulnerable neurons in the striatum and cortex express lower levels of HDGF than resistant ones. Moreover, lack of endogenous HDGF exacerbated motor impairments and reduced the life span of R6/2 Huntington's disease mice. AAV-mediated delivery of HDGF into the brain reduced mutant Huntingtin inclusion load, but had no significant effect on motor behavior or life span. Interestingly, both nuclear and cytoplasmic versions of HDGF were efficient in rescuing mutant Huntingtin toxicity in cellular HD models. Moreover, extracellular application of recombinant HDGF improved viability of mutant Huntingtin-expressing primary neurons and reduced mutant Huntingtin aggregation in neural progenitor cells differentiated from human patient-derived induced pluripotent stem cells. Our findings provide new insights into the pathomechanisms of HD and demonstrate neuroprotective potential of HDGF in neurodegeneration.

Valorisation of Buckwheat By-Product as a Health-Promoting Ingredient Rich in Fibre for the Formulation of Gluten-Free Bread.

Bread is a widely consumed food that has often been used as a vehicle for functional ingredients such as dietary fibre. Fibre-rich breads have beneficial physiological effects on health, helping to combat chronic pathologies such as cardiovascular disease, diabetes, and certain types of colon cancer. The aim of this study is to evaluate the technological and nutritional effects of the inclusion of buckwheat hull particles (BH) at two addition levels (3 and 6%) and two particle sizes (fine, D50: 62.7 µm; coarse, D50: 307 µm) in a gluten-free (GF) bread formulation. A significant (p < 0.05) increase in the dough elastic modulus (G') was observed for all doughs containing BH, from 712 Pa for a rice-based dough to 1027-3738 Pa for those containing BH. Compared to rice-based breads, those containing BH showed a significant (p < 0.05) increase in total dietary fibre content (from three to five times) and in antioxidant capacity (from 78 to 290 mg TE/100 g dw. in the ORAC test). Breads containing fine BH at a level of 3% had similar sensory properties to the rice-based bread, demonstrating that it is possible to improve the TDF content while maintaining the sensory quality of the GF bread.

Primary and secondary immune thrombocytopenia (ITP): Time for a rethink.

There are not many publications that provide a holistic view of the management of primary and secondary ITP as a whole, reflecting the similarities and differences between the two. Given the lack of major clinical trials, we believe that comprehensive reviews are much needed to guide the diagnosis and treatment of ITP today. Therefore, our review addresses the contemporary diagnosis and treatment of ITP in adult patients. With respect to primary ITP we especially focus on establishing the management of ITP based on the different and successive lines of treatment. Life-threatening situations, "bridge therapy" to surgery or invasive procedures and refractory ITP are also comprehensively reviewed here. Secondary ITP is studied according to its pathogenesis by establishing three major differential groups: Immune Thrombocytopenia due to Central Defects, Immune Thrombocytopenia due to Blocked Differentiation and Immune Thrombocytopenia due to Defective Peripheral Immune Response. Here we provide an up-to-date snapshot of the current diagnosis and treatment of ITP, including a special interest in addressing rare causes of this disease in our daily clinical practice. The target population of this review is adult patients only and the target audience is medical professionals.

Proteins and Minerals in Whey Protein Supplements.

Sports nutrition supplementation is a widespread practice. Whey protein supplements contribute not only to protein intake but also to dietary exposure to minerals. The labelling present provides the percentage of protein and rarely refers to other components, such as potentially toxic elements such as B, Cu, Mo, Zn, and V that present tolerable upper intake levels set by the European Food Safety Authority. The percentage of protein declared on supplement labelling was checked using the Kjeldahl method, and the levels of Ca, Mg, K, Na, Ba, B, Co, Cu, Cr, Sr, Fe, Li, Mn, Mo, Ni, V, Zn, and Al were analyzed by ICP-OES with the aim of characterizing the protein and mineral contents of isolate and concentrate whey protein supplements representative of the European market. The protein content was 70.9% (18-92.3%) and statistically significant differences were observed between the declared and real protein percentages. Among the minerals, K (4689.10 mg/kg) and Ca (3811.27 mg/kg) presented the highest levels, whereas Co (0.07 mg/kg) and V (0.04 mg/kg) showed the lowest levels. It was concluded that the quality and safety of these products needs to be monitored and regulated. A high degree of non-compliance with labelling claims was detected. Furthermore, the contributions to the recommended and tolerable intakes among regular consumers need to be assessed.

Metal and trace element concentrations in cetaceans worldwide: A review.

This bibliographical review is a compilation of different scientific publications that reported data on metal concentrations in the muscle tissue of different species of cetaceans from seas and oceans around the world. Forty-nine scientific articles were selected, published over a fifteen-year period (2006-2021) with data on heavy metals and trace elements. The different groups of cetaceans considered in this study generally presented low concentrations of Cd and Pb. The same cannot be said of Hg. The highest concentrations of Hg were found in the groups of false killer whales. Similarly, the use of these groups of cetaceans as bioindicators of metal contamination shows that the Mediterranean Sea is one of the most metallically contaminated areas in the world. This may be due to the closed nature of the Mediterranean Sea and to the fact that it is also a highly populated and industrialized area.

Soil physicochemical properties change by age of the oil palm crop.

For decades there have been controversies related to the changes generated by oil palm plantations in the physicochemical properties of the soil, soil biota, and ecological interactions. Therefore, the present investigation evaluated root diameter and biomass at three ages of oil palm cultivation. Besides, we evaluated the effect of the ages on the physicochemical parameters of the soil in comparison with pasture plots. To know the diameter, fresh, and dry biomass of roots, soil sampling was carried out around the oil palm (3-, 5-, and 15-years-old) at distances of 1, 2, and 3 m from the trunk plant. Also, to know the changes in the properties of the soil, the sampling was carried out randomly in the same plots and the pasture plot (control). The results showed that both the diameter and the fresh and dry root biomass increased in 15-year-old plantations compared with 3- and 5-year-old. In addition, correlation analysis and principal component analysis indicated that the parameters evaluated are associated with the adult age of the oil palm. Also, the results of soil physicochemical showed that low soil fertility was associated with an increase in the age of the palm.