Health-Related Quality of Life Long-Term Study in Lung Transplant Patients: A Single-Center Experience.

INTRODUCTION: Health-related quality of life (HRQL) assessment plays a crucial role in the follow-up care of lung transplanted (LTx) patients. Previous reports have indicated that the HRQL achieved by these patients is often poorer compared to that of healthy individuals. However, the factors contributing to this lower HRQL remain unclear. This prospective study aimed to assess the effectiveness of using both a generic and a disease-specific HRQL instrument in evaluating the outcomes of patients who have undergone LTx. METHODS: A total of 111 LTx patients were enrolled in the study, with 88 survivors completing the 5-year follow-up and 23 nonsurvivors identified within the first 3 y. Among the participants, 84 underwent double LTx, while 27 received a single LTx. Patients were interviewed before LTx, at 6 mo post-transplantation, and annually thereafter. Two validated instruments were utilized: the Euro quality of life five dimensions, a generic measure, and the St. George's Respiratory Questionnaire (SGRQ), a disease-specific questionnaire. RESULTS: The study showed significant improvements in Euro Quality of Life five Dimensions scores from 6 mo after LTx. Specifically, the percentage of patients without Mobility problems increased from 23% before LTx to 71% at 5 y (P = <0.001), while the ability to self-care improved from 48% to 100% (P = <0.001). The ability to carry out usual activities improved from 13% to 86% (P = <0.001), and the proportion of patients without anxiety and depression increased from 50% to 86% (P > 0.004). However, there was no significant improvement observed in Pain, with only a slight reduction from 57% to 42.8% (P = 0.22). The SGRQ also showed improvements in all dimensions (symptoms, impact, activities) (P < 0.001). However, by the fifth year, the HRQL scores remained below normal reference values. Chronic graft dysfunction was associated with a decline in SGRQ scores. Bilateral LTx patients exhibited better SGRQ scores compared to unilateral LTx patients from the first year post-transplantation. Notably, there were no differences in scores between nonsurvivors and survivors. CONCLUSIONS: The study highlights the long-term improvement in HRQL among LTx patients, with greater improvements observed in physical dimensions compared to psychological dimensions. Bilateral LTx was associated with better SGRQ scores than unilateral LTx, and chronic graft dysfunction primarily affected SGRQ scores. These findings underscore the importance of utilizing both generic and specific HRQL instruments in assessing LTx outcomes.

Spontaneous Emulsions: Adjusting Spontaneity and Phase Behavior by Hydrophilic-Lipophilic Difference-Guided Surfactant, Salt, and Oil Selection.

Spontaneous emulsion behavior has been difficult to predict and could be influenced by many variables including salinity, temperature, and chemical composition of the oil and surfactant. In this work, the hydrophilic-lipophilic difference (HLD) framework was used to predict the formation of spontaneous emulsions using a mixture of Span-80 and SLES surfactants. The spontaneity and emulsion behavior of different systems were modeled by estimating the HLDmix. The influence of surfactant ratio, salinity, and oil type was investigated. Spontaneous emulsification could only be observed when the HLDmix was between -0.96 and 1.04. Within this range, a negative HLDmix resulted in a greater spontaneity to form o/w emulsion, and a w/o emulsion was more likely to form when the HLDmix was positive. When the HLDmix was close to 0 (between -0.22 and 0.56 in our systems), emulsions were formed in both the oil and aqueous phases with high spontaneity. A combined effect of ultralow interfacial tension, Span-80 micelle swelling, and interfacial turbulence due to Marangoni effects is likely the main mechanism of the spontaneous emulsification observed in this study. A synergistic reduction in interfacial tension was observed between Span-80 and SLES (<1 mN/m). When the HLD of the system was close to 0, a bicontinuous emulsion phase was formed at the oil-water interface. The bicontinuous emulsion broke-up over time due to the ultralow interfacial tension and interfacial turbulence, forming dispersed oil and water droplets. Results from this work provide a practical method to suggest what surfactant composition, salinity, and oil type could promote (or eliminate) the conditions favorable for spontaneous emulsification.

Are the soils and vegetation of a forest close to tailings ponds affected by metals and arsenic?

This study aimed to determine the transfer of metals (Cd, Pb and Zn) and As to a Mediterranean forest close to five tailings ponds in Cartagena-La Union mining district (SE Spain). In addition, the effect of the rhizosphere of two native plant species, Olea europaea (OE) and Pistacia lentiscus (PL), on soil properties and chemical speciation of metal(oid)s was evaluated. Results showed there was no influence of the rhizosphere in the total concentration of metal(loid)s in soil, decreasing as Pb > Zn > As > Cd. Chemical partitioning revealed that only Cd and As can be considered hazardous, with a high percentage of these elements in the soil-labile fractions (20-40%). The accumulation in vegetal tissues was only high for Pb in PL roots, which makes it a suitable species for phytostabilization. Additionally, translocation factors showed transfer of Pb and Zn in OE, and Zn in PL to aerial parts, although no toxicity evidences for plants or animals were found. Finally, soil properties affected metal(loid)s accumulation in plants. The OE species was related to soil-labile metal(loid) fractions and pH, total N, organic carbon and silt content. The PL species were associated with immobilized metal(loid) fractions, sand content, electrical conductivity and total concentrations of As, Cd and Pb. Hence, mining activity has affected native adjacent soils, with accumulation of metals in plant species, although translocation was low, likely due to physiological strategies of the studied species to protect themselves against hazardous elements, and to the high soil pH, which limits metals' mobility.

Predicting Spontaneous Emulsification in Saltwater Environments Using the HLD Model.

Spontaneous emulsification of toluene with nonylphenol polyethoxylate (NPE) and sodium dodecylbenzenesulfonate (SDBS) surfactants in saltwater environments was studied. NaCl promoted the spontaneous emulsification of an otherwise non-spontaneous SDBS-toluene system. Dynamic light scattering and turbidity indicated that spontaneity increased with NaCl concentration. The mechanism of spontaneous emulsification was dependent on surfactant type; NPE emulsified via micelle swelling, and SDBS emulsified via nucleation and growth. Hydrophilic lipophilic difference (HLD) calculations were used to model spontaneous emulsification and spontaneity. As HLD approached zero, conditions became more favorable for spontaneous emulsification. Between HLD values of -2.4 and -2.05, samples transitioned from non-spontaneous to spontaneous. This study aids in predicting spontaneous emulsion formation in saltwater environments for applications in nanoemulsion formation and wastewater remediation.

'Absolute' inter-observer classifications agreement for proximal humeral fractures with a single shoulder anteroposterior X-ray.

PURPOSE: Several studies have been carried out, and there is no classification for proximal humeral fractures (PHF) exempted from variability in interpretation and with questioned reliability. In the present study, we investigated the 'absolute diagnostic reliability' of the most currently used classifications for PHFs on a single anterior-posterior X-ray shoulder image. METHODS: Six orthopaedic surgeons, with varying levels of experience in shoulder pathology, evaluated radiographs from 30 proximal humeral fractures, according to the 'absolute reliability' criteria. Each of the observers rated each fracture according to Neer, Müller/AO and Codman-Hertel's classification systems. RESULTS: The overall inter-observer agreement (κ) has been 0.297 (CI95% 0.280 to 0.314) for the Neer's classification system, 0.206 (CI95% 0.193 to 0.218) for the Müller/AO classification system, and 0.315 (CI95% 0.334 to 0.368) for the Codman-Hertel classification system. We found loss of agreement in Neer's classification as the study progressed, low agreement in the AO classification, and stable values in the different evaluations with the best degree of agreement for Codman-Hertel classification, with a moderate agreement in the second evaluation among the six evaluators. CONCLUSION: The Neer, AO, and Hertel-Codman classification systems for PHF with a single radiographic projection have a difficult interpretation for orthopaedic surgeons of varying levels of experience, and therefore substantial agreements are not obtained.

Diffusion-Controlled Spontaneous Emulsification of Water-Soluble Oils via Micelle Swelling.

Spontaneous emulsification of toluene, xylenes, cyclohexane, and mineral oil in a nonionic nonylphenol polyethoxylate surfactant solution was investigated by visual observations coupled with dynamic light scatting measurements and interfacial tensiometry. For water-soluble oils, nanoscale emulsions formed spontaneously by diffusion of oil molecules into the aqueous surfactant solutions and subsequent swelling of surfactant micelles with oil. Micelle swelling rates were quantified to assess system spontaneity, revealing that oil solubility in water was directly correlated to the spontaneity of the emulsion (toluene > xylenes > cyclohexane). When experiments were intentionally designed to create surfactant concentration gradients, Marangoni flows were found to enhance spontaneity. Despite their spontaneous formation, emulsion stability was limited over the course of 40 days by Ostwald ripening followed by creaming and evaporation. These results provide insights on the likelihood of nanoemulsion formation and persistence in oily wastewater as the components in this study are present in many wastewater systems.

Efficacy of laser application in dental bleaching: A randomized clinical controlled trial.

PURPOSE: To evaluate the bleaching efficacy of laser application with chemical treatment compared to chemical treatment alone. METHODS: This was a randomized controlled trial (RCT), single blind (evaluator), in 24 patients randomized into two groups: Laser and chemical intervention (12) or chemical intervention alone without laser (12). The commercial products used were Whiteness HP 35% hydrogen peroxide gel and the Whitening Laser II of DCM equipment. The color was measured with a spectrophotometer before, immediately and 3 days after the bleaching procedure. The trial outcome measures were obtained using the Vita EasyShade spectrophotometer and the International CIELCh system. To establish differences before vs. after treatments and between groups, the T test and chi² tests were applied. The data was statistically analyzed with Student's T-test (P ≤ 0.05). RESULTS: After applying the delta formula to measure the change in color, both groups gave clinically significant results before vs. after bleaching procedures ( P ≤ 0.05). The deltas for luminosity, chroma, and hue all showed significant improvements for baseline to 15 minutes post treatment (P ≤ 0.05), baseline to 3 days post treatment (P ≤ 0.05), but not for 15 minutes to 3 days post treatment (P ≥ 0.05). When comparing between groups applying T-test, no statistically significant differences were found (P ≥ 0.05) for all three deltas. When comparing sensitivity after bleaching, no differences were found between groups (P ≥ 0.05). CLINICAL SIGNIFICANCE: The use of laser during bleaching treatment did not improve the results compared to not using laser.

Effect of microbial immunostimulants on WSSV infection percentage and the expression of immune-related genes in white shrimp (Litopenaeus vannamei) / Efecto de los inmunoestimulantes microbianos en el porcentaje de infección con WSSV y la expresión de genes relacionados con el sistema inmune del camarón blanco (Litopenaeus vannamei) / Efeito de imunoestimulantes microbianos sobre a porcentagem de infecção por WSSV e a expressão de genes relacionados ao sistema imune em camarões brancos (Litopenaeus vannamei)

Abstract Background: The white spot syndrome virus (WSSV) causes high mortalities in aquaculture. The use of immunostimulants increases animal resistance. Objective: To evaluate the WSSV infection percentage and the immunostimulant effect of lactic acid bacteria and yeast (MI= microbial immunostimulants) on WSSV infected Litopenaeus vannamei. Methods: A bioassay was performed for 33 d, with treatments in triplicate. The MI was added to the feed at 8.5 mg/kg feed and offered to shrimp (9.9 ± 3.1 g) daily, every 2 days, or every 3 days. Shrimp were infected with WSSV at 9 and 19 days. The expression of four immune system-related genes was studied using qRT-PCR. Results: No significant differences were observed in growth and survival among treatments. At the end of the bioassay, WSSV infection percentage (low viral load) decreased 8.3 and 25% in treatments III and IV as compared to the control group. Treatments with MI showed significant differences in the relative expression of LvToll, transglutaminase, and prophenoloxidase genes when MI was offered daily as compared to the control group. The MI did not regulate the expression of the superoxide dismutase gene. The WSSV infection percentage decreased when feed with MI was offered every 3 d. Conclusion: The MI decrease WSSV infection percentage in L. vannamei infected with low viral load when it is offered every three days. The MI up-regulates LvToll, Tgase, and proPO genes when it is offered daily. Further research is needed regarding prophylactic treatment with microbial immunostimulants against WSSV in commercial shrimp farms.

Resumen Antecedentes: El virus del síndrome de la mancha blanca (WSSV) ocasiona alta mortalidad en acuacultura. El empleo de inmunoestimulantes incrementa la resistencia de los animales. Objetivo: Evaluar el porcentaje de infección de WSSV y el efecto inmunoestimulante de bacterias ácido lácticas y levadura (MI= inmunoestimulantes microbianos) en Litopenaeus vannamei infectado con WSSV. Métodos: Se realizó un bioensayo durante 33 días con tratamientos por triplicado. Se agregó MI al alimento (8,5 mg/kg de alimento), suministrandolo al camarón (9,9 ± 3,1 g) diariamente, cada 2, o cada 3 días. Los camarones se infectaron con WSSV a los 9 y 19 días. Se estudió la expresión de cuatro genes relacionados con el sistema inmune utilizando qRT-PCR. Resultados: No hubo diferencias significativas en el crecimiento y la sobrevivencia entre los tratamientos. Al final del bioensayo, el porcentaje de infección de WSSV (baja carga viral) disminuyó un 8,3 y un 25% en los tratamientos III y IV en comparación con el grupo control. Los tratamientos con MI mostraron diferencias significativas en la expresión relativa de los genes LvToll, transglutaminasa, y profenoloxidasa cuando se suministró MI diariamente en comparación con el grupo control. Los MI no regularon la expresión del gen de la superóxido dismutasa. El porcentaje de infección de WSSV disminuyó cuando el alimento con MI se aplicó cada 3 d. Conclusiones: Los MI disminuyen el porcentaje de infección de WSSV en L. vannamei infectado con baja carga viral cuando se aplican cada tres días. Además, los MI causan una sobre-expresión de los genes LvToll, Tgase y proPO cuando se administran diariamente. Se necesita más investigación sobre los inmunoestimulantes microbianos como tratamiento profiláctico contra WSSV en granjas comerciales de camarón.

Resumo Antecedentes: O vírus da mancha branca (WSSV) causa alta mortalidade na aqüicultura e o uso de imunoestimulantes aumenta a resistência em animais. Objetivo: Este trabalho avaliou a prevalência do WSSV e o efeito imunoestimulante de bactérias ácido lácticas e levadura (MI= inmunoestimulantes microbianos) em Litopenaeus vannamei infectado con WSSV. Métodos: Se realizou um bioensayo durante 33 dias com tratamientos por triplicado. Se agregou MI al alimento (8,5 mg/kg feed) e se o fornecimento de camarão (9,9 ± 3,1 g) diariamente, cada 2 e cada 3 d. Los camarones foram infectados com WSSV a los 9 y 19 d. Se estudió a expressão de quatro genes relacionados com o sistema imune, use qRT-PCR. Resultados: No hubo diferencias significativas no crescimento e na supervisão entre os tratamientos. Al final del bioensayo, a prevalência do WSSV diminuiu um 8.3 e não 25% nos tratamentos III e IV em comparação com o grupo de controle. Os tratamentos com MI mostraram diferenças significativas na expressão relativa dos genes. LvToll, transglutaminasa e prophenoloxidase quando se administraron em diários de MI em comparação com o controle de grupo. Los MI não regularam a expressão do genótipo da superóxido dismutasa. A prevalência do WSSV diminuiu quando o alimento com MI se aplicó cada 3 d. Conclusões: Los IM diminuir a prevalência de WSSV em L. vannamei infectado com baixa carga viral quando aplicável a cada três dias. Além disso, os IM causaram uma sobre-expressão dos genes LvToll, Tgase e proPO quando se administran diariamente. Há mais informações sobre imunoestimulantes microbianos como tratamento profiláctico contra WSSV en granjas comerciales de camarón.

EARLY COPD: determinantes de la aparición y progresión de la enfermedad pulmonar obstructiva crónica en adultos jóvenes. Protocolo de un estudio caso-control con seguimiento / Determinants of the Appearance and Progression of Early-Onset Chronic Obstructive Pulmonary Disease in Young Adults. A Case-Control Study with Follow-up

Introducción y objetivos: Los determinantes en fases iniciales de la historia natural de la enfermedad pulmonar obstructiva crónica (EPOC) son poco conocidos. Entenderlos mejor es de capital importancia para poder diseñar intervenciones dirigidas a modificar su pronóstico. Los principales objetivos del estudio son: a) caracterizar a una población de adultos jóvenes con EPOC de forma multidimensional; b) comparar estos pacientes con sujetos fumadores con función pulmonar normal; y c) establecer una cohorte de adultos jóvenes con y sin EPOC, que pueda ser seguida a largo plazo para conocer mejor la historia natural de la enfermedad. Participantes y método: EARLY COPD es un estudio multicéntrico de casos y controles que permitirá establecer una cohorte de sujetos para su seguimiento posterior. Se seleccionaron 311 (101 casos y 210 controles) participantes reclutados en una treintena de centros de atención primaria y 12 hospitales de 8 comunidades autónomas españolas. Los participantes eran fumadores o exfumadores (>10 paquetes año) de entre 35-50 años de edad. Los casos presentaban una espirometría obstructiva con un FEV1/FVC<70% y los controles una espirometría normal con un FEV1/FVC≥70%. Las principales variables de estudio que se han determinado son las siguientes: cuestionarios de salud, síntomas, exacerbaciones y actividad física, pruebas de función respiratoria, análisis biológicos de sangre y esputo y TAC de baja radiación. Para el análisis estadístico de los resultados se describirán las características de los pacientes con EPOC y se compararán con los sujetos del grupo control mediante un modelo de regresión logística

Introduction and objectives: Determinants of chronic obstructive pulmonary disease (COPD) in the early stages of its natural history are not well known. Improving our knowledge of these factors will help to design interventions that can modify prognosis. Study objectives are: a) to characterize a COPD population of young adults aged 35-50 years from a multidimensional point of view; b) to compare these patients with smokers with normal lung function; and c) to create a cohort of young adults aged 35-50 years (smokers or former smokers), with and without COPD, who will be followed in the future to improve understanding of the natural history of the disease. Participants and method: This is a case-control multicenter study aimed at establishing a well-characterized cohort of young adults, smokers or former-smokers, with and without COPD, for subsequent follow-up. A total of 311 participants (101 cases and 210 controls) were selected from approximately 30 primary care settings and 12 hospitals in 8 Spanish regions. Subjects were smokers or former smokers (>10 pack-years) aged 35-50 years. Diagnosis of COPD was based on a post-bronchodilator result of FEV1/FVC<70%. The main study variables were: questionnaires on health, symptoms, exacerbations and daily physical activity, lung function tests, blood and sputum samples, and low-dose computed tomography. In the statistical analysis, COPD patient characteristics will be described and compared with control subjects using a logistic regression analysis

Determinants of the Appearance and Progression of Early-Onset Chronic Obstructive Pulmonary Disease in Young Adults. A Case-Control Study with Follow-up. / EARLY COPD: determinantes de la aparición y progresión de la enfermedad pulmonar obstructiva crónica en adultos jóvenes. Protocolo de un estudio caso-control con seguimiento.

INTRODUCTION AND OBJECTIVES: Determinants of chronic obstructive pulmonary disease (COPD) in the early stages of its natural history are not well known. Improving our knowledge of these factors will help to design interventions that can modify prognosis. Study objectives are: a) to characterize a COPD population of young adults aged 35-50 years from a multidimensional point of view; b) to compare these patients with smokers with normal lung function; and c) to create a cohort of young adults aged 35-50 years (smokers or former smokers), with and without COPD, who will be followed in the future to improve understanding of the natural history of the disease. PARTICIPANTS AND METHOD: This is a case-control multicenter study aimed at establishing a well-characterized cohort of young adults, smokers or former-smokers, with and without COPD, for subsequent follow-up. A total of 311 participants (101 cases and 210 controls) were selected from approximately 30 primary care settings and 12 hospitals in 8 Spanish regions. Subjects were smokers or former smokers (>10 pack-years) aged 35-50 years. Diagnosis of COPD was based on a post-bronchodilator result of FEV1/FVC<70%. The main study variables were: questionnaires on health, symptoms, exacerbations and daily physical activity, lung function tests, blood and sputum samples, and low-dose computed tomography. In the statistical analysis, COPD patient characteristics will be described and compared with control subjects using a logistic regression analysis.

La auditoría clínica y su circunstancia / Clinical audit: Why, where and how?

No disponible

Normativa sobre el manejo del nódulo pulmonar solitario / Guideline on Management of Solitary Pulmonary Nodule

Las recomendaciones que se proponen pretenden ser un instrumento que facilite la toma de decisiones en pacientes con nódulo pulmonar solitario (NPS). Para una decisión óptima hay que incorporar la accesibilidad a las distintas técnicas diagnósticas y las preferencias del paciente. La primera valoración, que incluye la tomografía computarizada torácica, separa a un grupo de pacientes con neoplasia extrapulmonar o muy alto riesgo quirúrgico que requieren manejo individualizado. Otros 2 grupos son los pacientes con NPS de hasta 8 mm y los que tienen NPS subsólido, para los que se establecen recomendaciones específicas. Los NPS mayores de 8 mm se clasifican según su probabilidad de malignidad en baja (menor del 5%) donde se recomienda observación, alta (mayor del 65%) que se manejan con el diagnóstico de presunción de carcinoma en estadio localizado, e intermedia, donde la tomografía de emisión de positrones tiene gran rendimiento para reclasificarlos en alta o baja probabilidad. En los casos de probabilidad de malignidad intermedia o alta puede ser una opción la punción o biopsia transbronquial del nódulo. Se recomienda la observación radiológica con tomografía computarizada de baja radiación y sin contraste en el NPS con baja probabilidad de malignidad, y la resección con videotoracoscopia en los casos no diagnosticados y con probabilidad de malignidad intermedia o alta

The aim of the proposed recommendations is to be a tool to facilitate decision-making in patients with a solitary pulmonary nodule (SPN). For an optimal decision, accessibility to the different diagnostics techniques and patient preferences need to be incorporated. The first assessment, which includes a chest computed tomography scan, separates a group of patients with extrapulmonary neoplasm or a high surgical risk who require individualized management. Another two groups of patients are patients with SPN up to 8 mm and those who have a subsolid SPN, for which specific recommendations are established. SPNs larger than 8 mm are classified according to their probability of malignancy into low (less than 5%), where observation is recommended, high (higher than 65%), which are managed with a presumptive diagnosis of localized stage carcinoma, and intermediate, where positron emission tomography-computed tomography has high yield for reclassifying them into high or low probability. In cases of intermediate or high probability of malignancy, transbronchial needle aspiration or biopsy of the nodule may be an option. Radiologic observation with low radiation computed tomography without contrast is recommended in SPN with low probability of malignancy, and resection with videothoracoscopy in undiagnosed cases with intermediate or high probability of malignancy

Guideline on management of solitary pulmonary nodule.

The aim of the proposed recommendations is be a tool to facilitate decision-making in patients with a solitary pulmonary nodule (SPN). For an optimal decision, accessibility to the different diagnostics techniques and patient preferences need to be incorporated. The first assessment, which includes a chest computed tomography scan, separates a group of patients with extrapulmonary neoplasm or a high surgical risk who require individualized management. Another two groups of patients are patients with SPN up to 8mm and those who have a subsolid SPN, for which specific recommendations are established. SPN larger than 8mm are classified according to their probability of malignancy into low (less than 5%), where observation is recommended, high (higher than 65%), which are managed with a presumptive diagnosis of localized stage carcinoma, and intermediate, where positron emission tomography-computed tomography has high yield for reclassifying them into high or low probability. In cases of intermediate or high probability of malignancy, transbronchial needle aspiration or biopsy of the nodule may be an option. Radiologic observation with low radiation computed tomography without contrast is recommended in SPN with low probability of malignancy, and resection with videothoracoscopy in undiagnosed cases with intermediate or high probability of malignancy.

Modeling of nanotherapeutics delivery based on tumor perfusion.

Heterogeneities in the perfusion of solid tumors prevent optimal delivery of nanotherapeutics. Clinical imaging protocols to obtain patient-specific data have proven difficult to implement. It is challenging to determine which perfusion features hold greater prognostic value and to relate measurements to vessel structure and function. With the advent of systemically administered nanotherapeutics, whose delivery is dependent on overcoming diffusive and convective barriers to transport, such knowledge is increasingly important. We describe a framework for the automated evaluation of vascular perfusion curves measured at the single vessel level. Primary tumor fragments, collected from triple-negative breast cancer patients and grown as xenografts in mice, were injected with fluorescence contrast and monitored using intravital microscopy. The time to arterial peak and venous delay, two features whose probability distributions were measured directly from time-series curves, were analyzed using a Fuzzy C-mean (FCM) supervised classifier in order to rank individual tumors according to their perfusion characteristics. The resulting rankings correlated inversely with experimental nanoparticle accumulation measurements, enabling modeling of nanotherapeutics delivery without requiring any underlying assumptions about tissue structure or function, or heterogeneities contained within. With additional calibration, these methodologies may enable the study of nanotherapeutics delivery strategies in a variety of tumor models.

Assembly of colloidal silica crystals inside double emulsion drops.

We investigated the assembly of colloidal silica crystals inside double emulsion drops generated in microcapillary microfluidic devices. The double emulsions are composed of an aqueous suspension of monodisperse silica particles in the inner drop surrounded by a PDMS oil drop that acts as a semipermeable membrane for the diffusion of water into or out of the inner drop in the presence of an osmotic gradient. Imposing a high osmotic pressure in the continuous phase induces water diffusion out of the inner drop, increasing the silica volume fraction (φ(silica)) and leading to the formation of a spherical colloidal silica crystal. Silica suspensions with no salt or low salt concentration (<10(-3) M) formed colloidal crystals with φ(silica) up to 0.68. Monodisperse spherical colloidal silica crystals with sizes ranging from 16 to 133 µm were generated by varying the device geometry, flow-rate ratios, and initial silica fraction. At salt concentrations > 10(-3) M, the electrostatic repulsion is reduced, and crystallization is suppressed. Crystals were preserved in a hydrogel matrix or inside a silicone rubber shell. This study demonstrates a robust path for controlled colloidal assembly inside double emulsion drops.

Altering colloidal surface functionalization using DNA encapsulated inside monodisperse gelatin microsphere templates.

Soluble oligonucleotides are typically introduced to bulk solution to promote hybridization activity on DNA-functionalized surfaces. Here, an alternative approach is explored by encapsulating secondary target strands inside semipermeable colloidal satellite assemblies, then triggering their release at 37 °C for subsequent surface hybridization activity. To prepare DNA-loaded satellite assemblies, uniform gelatin microspheres are fabricated using microfluidics, loaded with 15 base-long secondary DNA targets, capped with a polyelectrolyte bilayer, and finally coated with a monolayer of polystyrene microspheres functionalized with duplexes comprised of immobilized probes and soluble, 13 base-long hybridization partner strands. Once warmed to 37 °C, secondary DNA targets are released from the gelatin template and then competitively displace the shorter, original hybridization partners on the polystyrene microspheres.

Clinical audit of COPD patients requiring hospital admissions in Spain: AUDIPOC study.

BACKGROUNDS: AUDIPOC is a nationwide clinical audit that describes the characteristics, interventions and outcomes of patients admitted to Spanish hospitals because of an exacerbation of chronic obstructive pulmonary disease (ECOPD), assessing the compliance of these parameters with current international guidelines. The present study describes hospital resources, hospital factors related to case recruitment variability, patients' characteristics, and adherence to guidelines. METHODOLOGY/PRINCIPAL FINDINGS: An organisational database was completed by all participant hospitals recording resources and organisation. Over an 8-week period 11,564 consecutive ECOPD admissions to 129 Spanish hospitals covering 70% of the Spanish population were prospectively identified. At hospital discharge, 5,178 patients (45% of eligible) were finally included, and thus constituted the audited population. Audited patients were reassessed 90 days after admission for survival and readmission rates. A wide variability was observed in relation to most variables, hospital adherence to guidelines, and readmissions and death. Median inpatient mortality was 5% (across-hospital range 0-35%). Among discharged patients, 37% required readmission (0-62%) and 6.5% died (0-35%). The overall mortality rate was 11.6% (0-50%). Hospital size and complexity and aspects related to hospital COPD awareness were significantly associated with case recruitment. Clinical management most often complied with diagnosis and treatment recommendations but rarely (<50%) addressed guidance on healthy life-styles. CONCLUSIONS/SIGNIFICANCE: The AUDIPOC study highlights the large across-hospital variability in resources and organization of hospitals, patient characteristics, process of care, and outcomes. The study also identifies resources and organizational characteristics associated with the admission of COPD cases, as well as aspects of daily clinical care amenable to improvement.

Use of the Objective Grading System of the American Board of Orthodontics to evaluate treatment at the Orthodontic Graduate Program Clinic, University of Puerto Rico, 2007-2008.

OBJECTIVE: The Objective Grading System (OGS) was introduced in 1999 by the American Board of Orthodontics (ABO) as an instrument to reduce subjectivity when evaluating cases submitted to the ABO for examination. The objectives of this study were (1) to employ the OGS to determine the percentage of treated and completed cases from the University of Puerto Rico's (UPR) Orthodontic Graduate Program Clinic that would have earned a passing OGS score (according to the ABO standards) and (2) to assess the contribution of various patient characteristics and factors to this score. METHODS: A total of 64 cases completed during 2007 and 2008 met the inclusion criteria and were evaluated by a calibrated examiner using the OGS. Logistic regression and multiple regression analyses were performed to assess the association between the explanatory variables and the overall OGS score. RESULTS: Of the cases evaluated, 18.8% received a passing OGS score of <20, 34.4% received a borderline score of 20-30, and 46.9% received a failing score of >30. The mean OGS score was 32.17 +/- 13.03 points, similar to the mean OGS score of 34.36 +/- 10.39 reported in 2004 by a similar study. CONCLUSION: This study demonstrate that 53% of the completed cases at the university clinic obtained a potential passing score as per the ABO (OGS <30 points). Multiple and logistic regression analyses could neither explain the relationship between the explanatory variables and the OGS scores nor predict the probability of a particular case's passing when all variables were considered.