Genetics of inborn errors of immunity: Diagnostic strategies and new approaches to CNV detection.

BACKGROUND: Genetic diagnosis of inborn errors of immunity (IEI) is complex due to the large number of genes involved and their molecular features. Missense variants have been reported as the most common cause of IEI. However, the frequency of copy number variants (CNVs) may be underestimated since their detection requires specific quantitative techniques. At this point, the use of Next Generation Sequencing (NGS) is acquiring relevance. METHODS: In this article, we present our experience in the genetic diagnosis of IEI based on three diagnostic algorithms that allowed the detection of single nucleotide variants (SNVs) and CNVs. Following this approximation, 703 index cases were evaluated between 2014 and 2021. Sanger sequencing, MLPA, CGH array, breakpoint spanning PCR or a customized NGS-based multigene-targeted panel were performed. RESULTS: A genetic diagnosis was reached in 142 of the 703 index cases (20%), 19 of them presented deletions as causal variants. Deletions were also detected in 5 affected relatives and 16 healthy carriers during the family studies. Additionally, we compile, characterize and present all the CNVs detected by our diagnostic algorithms, representing the largest cohort of deletions related to IEI to date. Furthermore, three bioinformatic tools (LACONv, XHMM, VarSeq™) based on NGS data were evaluated. VarSeq™ was the most sensitive and specific bioinformatic tool; detecting 21/23 (91%) deletions located in captured regions. CONCLUSION: Based on our results, we propose a strategy to guide the molecular diagnosis that can be followed by expert and non-expert centres in the field of IEI.

The challenge of standardizing CAR-T cell monitoring: A comparison of two flow-cytometry methods and correlation with qPCR technique.

Chimeric antigen receptor (CAR) T-cell therapy is a breakthrough in hematologic malignancies, such as acute B lymphoblastic leukemia (B-ALL). Monitoring this treatment is recommended, although standardized protocols have not been developed yet. This work compares two flow cytometry monitoring strategies and correlates this technique with qPCR method. CAR-T cells were detected by two different flow-cytometry protocols (A and B) in nine blood samples from one healthy donor and five B-ALL patients treated with Tisagenlecleucel (Kymriah®, USA). HIV-1 viral load allowed CAR detection by qPCR, using samples from seven healthy donors and nine B-ALL patients. CAR detection by protocol A and B did not yield statistically significant differences (1.9% vs. 11.8% CD3 + CAR+, p = 0.07). However, protocol B showed a better discrimination of the CD3 + CAR+ population. A strong correlation was observed between protocol B and qPCR (r = 0.7, p < 0.0001). CD3 + CAR+ cells were detected by flow cytometry only when HIV-1 viral load was above 104 copies/mL. In conclusion, protocol B was the most specific flow-cytometry procedure for the identification of CAR-T cells and showed a high correlation with qPCR. Further efforts are needed to achieve a standardized monitoring approach.

Utilidad de las terapias complementarias en el manejo de dolor durante el parto: una revisión integradora / Utility of complementary therapies in pain management during childbirth: an integrative literature review

Introducción: El dolor de parto es uno de los aspectos que más preocupan a las futuras madres. La enfermería vela por el bienestar de las pacientes en todas sus vertientes y cabe tener presente que existen diversas opciones complementarias a la analgesia epidural. Objetivo: Identificar las terapias complementarias que puedan aplicarse de forma efectiva y segura en embarazadas, analizar los factores que contribuyan a un mayor bienestar para la parturienta y evaluar su utilidad. Método: Revisión integradora de la literatura realizada mediante la búsqueda en las bases de datos online: PubMed, Scopus y Dialnet. Se incluyeron artículos cuya fecha de publicación no fuese superior a los 10 años previos a la búsqueda, redactados en inglés, español o portugués y de acceso abierto. Resultados: Se analizaron un total de 16 artículos cuya temática giraba en torno a la aplicación de diferentes terapias complementarias utilizadas con seguridad en mujeres embarazadas. Se tuvieron en cuenta los resultados de la aplicación de diferentes técnicas complementarias en estudios previos y se agruparon según tipología: intervenciones cuerpo-mente, práctica médica alternativa, métodos de curación manual, inmersión en agua y pelota suiza, aromaterapia y auriculoterapia y estimulación nerviosa eléctrica transcutánea. Conclusión: Se evidencia la variedad de terapias complementarias cuya aplicación resulta efectiva y segura en el momento del parto, así como su utilidad para disminuir los inconvenientes presentes durante esta etapa, acrecentando así, la experiencia positiva del parto. (AU)

Introduction: Labour pain is one of the most worrying things for future mothers. Nurses ensure the well-being of patients in all these aspects and it should be noted that there are various complementary options to epidural analgesia. Objective: To identify the complementary therapies that could be applied effectively and safely in pregnant women, to analyse the contributing factors of greater well-being for the parturient and to evaluate their utility. Method: this integrative review were carried out in online databases: PubMed, Scopus and Dialnet, Articles whose publication date was not more than ten years ago, written in English, Spanish or Portuguese and open access were included. Results: 16 studies about the application of different complementary therapies used safely in pregnant were included and analysed. The obtained results of the application of complementary techniques in previous studies were taken into account and agruped according to typology: body-mind interventions, alternative medical practice, manual healing methods, immersion in water and swiss ball, aromatherapy and auriculotherapy and transcutaneous electrical nerve stimulation. Conclusion: The variety of effective and safe complementary therapies on labour is evidencied, as well as their usefulness to reduce the possible incoveniences that may appear during this process, increasing the positive experience of labour. (AU)

Actitudes y percepciones de las enfermeras hacia la conducta suicida: Revisión sistemática de estudios cualitativos / Nurses' attitudes and perceptions towards suicidal behaviour: Systematic review of qualitative studies

Objetivo principal: Conocer las percepciones y actitudes hacia la conducta suicida por parte de las enfermeras, así como su influencia en la evaluación y abordaje de esta. Metodología: Revisión sistemática de estudios cualitativos que sigue el modelo de metasíntesis para el análisis de los resultados. Resultados: El total de artículos incluidos en el trabajo han sido trece, a través de los cuales, se han obtenido cuatro categorías temáticas que sintetizan los resultados de los estudios evaluados. Conclusiones: El trabajo aporta una visión del camino que se está recorriendo, desde una postura moralista hacia la conducta suicida, a la comprensión de la patología que se ha de evaluar, tratar y prevenir.(AU)

Main objective: To know the perceptions and attitudes towards suicidal behaviour by nurses, as well as their influence on its evaluation and approach to it. Methodology: Systematic review of qualitative studies that follows the metasynthesis model for the analysis of results. Results: The total number of articles included in this paper has been thirteen, through which, four thematic categories that summarise the results of the evaluated studies have been obtained. Conclusions: The paper provides a vision of the path that is being followed, from a moralistic stance towards suicidal behaviour, to the understanding of the pathology that has to be assessed, treated and prevented.(AU)

Analysis of Psychosomatic Disorders According to Age and Sex in a Rural Area: A Population-Based Study.

Psychosomatic disorders can develop unevenly depending on certain health determinants; therefore, the aim of this study was to analyze the prevalence of psychosomatic disorders and the differences by age and sex in a rural area. We conducted an observational descriptive retrospective population study to determine the prevalence of 201 diagnoses of psychosomatic nature grouped into 25 diagnostic categories by sex and age groups. A total of 33,680 participants with a diagnosis of psychosomatic disorder were identified (64.6% women, 35.4% men). We found statistically significant differences based on sex in 13 of the 25 diagnostic categories previously defined. When we analyzed these categories by age, we found that women showed a higher probability, between 1.23 and 10.85 times, of suffering from most of these health issues. We also observed that the older the age group, the most often they had a diagnosis. Notably, more women seem to suffer from psychosomatic disorders when compared to men in the same situation. In most of these disorders, being of the female sex was a risk factor, and the older the participants, the greater the probability of developing a disorder.

Variants in CASP10, a diagnostic challenge: Single center experience and review of the literature.

Autoimmune lymphoproliferative syndrome is a primary immunodeficiency caused by variants in FAS-mediated apoptosis related genes and is characterized by lymphadenopathy, splenomegaly and autoimmunity. A total of six different variants in CASP10 have been described as potential causative of disease, although two of them have recently been considered polymorphisms. The high allele frequency of these variants in healthy population in addition to the broad clinical spectrum of the disease difficult the interpretation of their pathogenicity. Here, we describe the clinical and analytical findings of three new patients carrying variants in CASP10 and summarize 12 more cases from the literature. Autoimmune cytopenias, adenopathies and increment of TCRαß+CD4-CD8- cells have been the most common findings, being possibly the FAS-mediated apoptosis pathway the pathogenic mechanism of this disease. The clinical impact and the consequences of CASP10 variants are not fully elucidated, therefore the description of new cases will contribute to solve this issue.

Recent Advances in Nanoporous Anodic Alumina: Principles, Engineering, and Applications.

The development of aluminum anodization technology features many stages. With the story stretching for almost a century, rather straightforward-from current perspective-technology, raised into an iconic nanofabrication technique. The intrinsic properties of alumina porous structures constitute the vast utility in distinct fields. Nanoporous anodic alumina can be a starting point for: Templates, photonic structures, membranes, drug delivery platforms or nanoparticles, and more. Current state of the art would not be possible without decades of consecutive findings, during which, step by step, the technique was more understood. This review aims at providing an update regarding recent discoveries-improvements in the fabrication technology, a deeper understanding of the process, and a practical application of the material-providing a narrative supported with a proper background.

Supported Ultra-Thin Alumina Membranes with Graphene as Efficient Interference Enhanced Raman Scattering Platforms for Sensing.

The detection of Raman signals from diluted molecules or biomaterials in complex media is still a challenge. Besides the widely studied Raman enhancement by nanoparticle plasmons, interference mechanisms provide an interesting option. A novel approach for amplification platforms based on supported thin alumina membranes was designed and fabricated to optimize the interference processes. The dielectric layer is the extremely thin alumina membrane itself and, its metallic aluminum support, the reflecting medium. A CVD (chemical vapor deposition) single-layer graphene is transferred on the membrane to serve as substrate to deposit the analyte. Experimental results and simulations of the interference processes were employed to determine the relevant parameters of the structure to optimize the Raman enhancement factor (E.F.). Highly homogeneous E.F. over the platform surface are obtained, typically 370 ± (5%), for membranes with ~100 nm pore depth, ~18 nm pore diameter and the complete elimination of the Al2O3 bottom barrier layer. The combined surface enhanced Raman scattering (SERS) and interference amplification is also demonstrated by depositing ultra-small silver nanoparticles. This new approach to amplify the Raman signal of analytes is easily obtained, low-cost and robust with useful enhancement factors (~400) and allows only interference or combined enhancement mechanisms, depending on the analyte requirements.

Tunable Nanoporous Anodic Alumina Photonic Crystals by Gaussian Pulse Anodization.

This study presents a Gaussian pulse anodization approach to generate nanoporous photonic crystals with highly tunable and controllable optical properties across the visible-NIR spectrum. Nanoporous anodic alumina Gaussian photonic crystals (NAA-GPCs) are fabricated in oxalic acid electrolyte by Gaussian pulse anodization, a novel form of pulse-like anodization. The effect of the Gaussian pulse width in the anodization profile on the optical properties of these photonic crystals is assessed by systematically varying this fabrication parameter from 5 to 60 s. The optical features of the characteristic photonic stopband (PSB) of NAA-GPCs-the position of the central wavelength, full width at half-maximum, and intensity-are found to be highly dependent on the Gaussian pulse width, the angle of incidence of incoming photons, and the nanopore diameter of NAA-GPCs. The effective medium of NAA-GPCs is assessed by monitoring spectral shifts in their characteristic PSB upon infiltration of their nanoporous structure with analytical solutions of d-glucose of varying concentration (0.0125-1 M). Experimental results are validated and mechanistically described by theoretical simulations, using the Looyenga-Landau-Lifshitz effective medium approximation model. Our findings demonstrate that Gaussian pulse anodization is an effective nanofabrication approach to producing highly sensitive NAA-based PC structures with versatile and tunable PSBs across the spectral regions. The findings provide new exiting opportunities to integrate these unique PC structures into photonic sensors and other platform materials for light-based technologies.

Selective and Sensitive Probe Based in Oligonucleotide-Capped Nanoporous Alumina for the Rapid Screening of Infection Produced by Candida albicans.

A robust, sensitive, and time-competitive system to detect Candida albicans in less than 30 min in clinical samples based in capped nanoporous anodic alumina (NAA) is developed. In the proposed design, NAA pores are loaded with rhodamine B and then blocked with an oligonucleotide that is able to recognize C. albicans DNA. The capped material shows negligible cargo release, whereas dye delivery is selectively accomplished when genomic DNA from C. albicans is present. This procedure has been successfully applied to detect C. albicans in clinical samples from patients infected with this yeast. When compared with classical C. albicans detection methods, the proposed probe has a short assay time, high sensitivity and selectivity, demonstrating the high potential of this simple design for the diagnosis of infection produced by C. albicans.

Real-Time Monitoring of Biotinylated Molecules Detection Dynamics in Nanoporous Anodic Alumina for Bio-Sensing.

The chemical modification, or functionalization, of the surfaces of nanomaterials is a key step to achieve biosensors with the best sensitivity and selectivity. The surface modification of biosensors usually comprises several modification steps that have to be optimized. Real-time monitoring of all the reactions taking place during such modification steps can be a highly helpful tool for optimization. In this work, we propose nanoporous anodic alumina (NAA) functionalized with the streptavidin-biotin complex as a platform towards label-free biosensors. Using reflective interferometric spectroscopy (RIfS), the streptavidin-biotin complex formation, using biotinylated thrombin as a molecule model, was monitored in real-time. The study compared the performance of different NAA pore sizes in order to achieve the highest response. Furthermore, the optimal streptavidin concentration that enabled the efficient detection of the biotinylated thrombin attachment was estimated. Finally, the ability of the NAA-RIfS system to quantify the concentration of biotinylated thrombin was evaluated. This study provides an optimized characterization method to monitor the chemical reactions that take place during the biotinylated molecules attachment within the NAA pores.

Stacked Nanoporous Anodic Alumina Gradient-Index Filters with Tunable Multispectral Photonic Stopbands as Sensing Platforms.

This study presents the development and optical engineering of stacked nanoporous anodic alumina gradient-index (NAA-GIFs) filters with tunable multispectral photonic stopbands for sensing applications. The structure of these photonic crystals (PC) is formed by stacked layers of NAA produced with sinusoidally modified effective medium. The progressive modification of the sinusoidal period during the anodization process enables the generation and precise tuning of the characteristic photonic stopbands (PSB) (i.e., one per sinusoidal period in the anodization profile) of these PC structures. Four types of NAA-GIFs featuring three distinctive PSBs positioned within the visible spectral region are developed. The sensitivity of the effective medium of these NAA-GIFs is systematically assessed by measuring spectral shifts in the characteristic PSBs upon infiltration of their nanoporous structure with analytical solutions of d-glucose with several concentrations (0.025-1 M). This study provides new insights into the intrinsic relationship between the nanoporous architecture of these PCs and their optical properties, generating opportunities to fabricate advanced optical sensing systems for high-throughput and multiplexed detection of analytes in a single sensing platform.

Nanoporous Anodic Alumina Surface Modification by Electrostatic, Covalent, and Immune Complexation Binding Investigated by Capillary Filling.

The fluid imbibition-coupled laser interferometry (FICLI) technique has been applied to detect and quantify surface changes and pore dimension variations in nanoporous anodic alumina (NAA) structures. FICLI is a noninvasive optical technique that permits the determination of the NAA average pore radius with high accuracy. In this work, the technique is applied after each step of different surface modification paths of the NAA pores: (i) electrostatic immobilization of bovine serum albumin (BSA), (ii) covalent attachment of streptavidin via (3-aminipropyl)-triethoxysilane and glutaraldehyde grafting, and (iii) immune complexation. Results show that BSA attachment can be detected as a reduction in estimated radius from FICLI with high accuracy and reproducibility. In the case of the covalent attachment of streptavidin, FICLI is able to recognize a multilayer formation of the silane and the protein. For immune complexation, the technique is able to detect different antibody-antigen bindings and distinguish different dynamics among different immune species.

3D Nanoporous Anodic Alumina Structures for Sustained Drug Release.

The use of nanoporous anodic alumina (NAA) for the development of drug delivery systems has gained much attention in recent years. The release of drugs loaded inside NAA pores is complex and depends on the morphology of the pores. In this study, NAA, with different three-dimensional (3D) pore structures (cylindrical pores with several pore diameters, multilayered nanofunnels, and multilayered inverted funnels) were fabricated, and their respective drug delivery rates were studied and modeled using doxorubicin as a model drug. The obtained results reveal optimal modeling of all 3D pore structures, differentiating two drug release stages. Thus, an initial short-term and a sustained long-term release were successfully modeled by the Higuchi and the Korsmeyer-Peppas equations, respectively. This study demonstrates the influence of pore geometries on drug release rates, and further presents a sustained long-term drug release that exceeds 60 days without an undesired initial burst.

A Mycoplasma Genomic DNA Probe using Gated Nanoporous Anodic Alumina.

A nanoporous anodic alumina (NAA)-based sensor system for the detection of Mycoplasma was developed through the implementation of "molecular gates" selective to the presence of this bacterium. The capped support showed a negligible cargo release, while presence of Mycoplasma genomic DNA resulted in the release of rhodamine B fluorescent dye. This sensor system presents a limit of detection of 20 genomic DNA copies⋅µL-1 and was applied to the detection of Mycoplasma bacteria in competitive environments, such as culture cell media.

Molecular gated nanoporous anodic alumina for the detection of cocaine.

We present herein the use of nanoporous anodic alumina (NAA) as a suitable support to implement "molecular gates" for sensing applications. In our design, a NAA support is loaded with a fluorescent reporter (rhodamine B) and functionalized with a short single-stranded DNA. Then pores are blocked by the subsequent hybridisation of a specific cocaine aptamer. The response of the gated material was studied in aqueous solution. In a typical experiment, the support was immersed in hybridisation buffer solution in the absence or presence of cocaine. At certain times, the release of rhodamine B from pore voids was measured by fluorescence spectroscopy. The capped NAA support showed poor cargo delivery, but presence of cocaine in the solution selectively induced rhodamine B release. By this simple procedure a limit of detection as low as 5 × 10-7 M was calculated for cocaine. The gated NAA was successfully applied to detect cocaine in saliva samples and the possible re-use of the nanostructures was assessed. Based on these results, we believe that NAA could be a suitable support to prepare optical gated probes with a synergic combination of the favourable features of selected gated sensing systems and NAA.

Optical Monitoring of the Capillary Filling Dynamics Variation in Nanoporous Anodic Alumina toward Sensing Applications.

Fluid imbibition-coupled laser interferometry (FICLI) is a technique in which the kinetics of a fluid infiltrating a nanoporous anodic alumina (NAA) membrane is monitored by the interference of a laser beam at the membrane top and bottom surfaces. Further processing of the measured data results in an estimate of the pore radius. In this work, we study the accuracy of FICLI in the detection of small changes in pore radius, and we evaluate the possibility of using such detection as a sensing paradigm. The accuracy is estimated by measuring samples with increasing pore radius, obtained by successive wet etching steps, and repeatability is evaluated by using different liquids. For decreasing pore radius, samples obtained by the successive deposition of polyelectrolyte double layers are used. With the aim of evaluating the possibility of the FICLI method to sense biological binding events, BSA attachment detection is demonstrated by applying FICLI to samples before and after immobilization of the protein. Results show that the technique permits an accurate estimation of the pore radius, the pore-etching rate (with a radius variation of retch,DI = 1.05 nm/min ± 0.11 nm/min), and the polyelectrolyte double layer thickness (with a radius variation of rPAH/PSS = 3.2 nm ± 0.2 nm per polyelectrolyte double layer). Furthermore, the pore radius reduction measured after BSA immobilization (dBSA = 4.9 nm ± 1.1 nm) is in good agreement with the protein size, as reported in the literature. With these results, we provide a sound basis for the applicability of FICLI as a sensitive technique for the characterization of NAA pore radius modifications.

Sustained, Controlled and Stimuli-Responsive Drug Release Systems Based on Nanoporous Anodic Alumina with Layer-by-Layer Polyelectrolyte.

Controlled drug delivery systems are an encouraging solution to some drug disadvantages such as reduced solubility, deprived biodistribution, tissue damage, fast breakdown of the drug, cytotoxicity, or side effects. Self-ordered nanoporous anodic alumina is an auspicious material for drug delivery due to its biocompatibility, stability, and controllable pore geometry. Its use in drug delivery applications has been explored in several fields, including therapeutic devices for bone and dental tissue engineering, coronary stent implants, and carriers for transplanted cells. In this work, we have created and analyzed a stimuli-responsive drug delivery system based on layer-by-layer pH-responsive polyelectrolyte and nanoporous anodic alumina. The results demonstrate that it is possible to control the drug release using a polyelectrolyte multilayer coating that will act as a gate.