Efficacy of an aloe vera, chamomile, and thyme cosmetic cream for the prophylaxis and treatment of mild dermatitis induced by radiation therapy in breast cancer patients (the Alantel study).

Objectives: Radiation-induced dermatitis (RD) is one of the most common toxicities in radiation therapy (RT) patients. Corticosteroids, immunosuppressants, and natural products (NPs) have been used as treatment. The objective was to evaluate the efficacy of a NPs-based cream (Alantel®) to reduce the incidence of RD in women with breast cancer undergoing RT treatment. Design: We conducted a controlled, randomized, double-blind clinical trial. Setting: Radiation Oncology Unit of the Reina Sofía Hospital and 5 Primary Care centers of the Cordoba and Guadalquivir Health District (Spain). Interventions: Patients assigned to the experimental group (GTA) were treated with Alantel, while those in the control group (GTE) were treated with a moisturizer and emollient cream. Main outcome measures: The primary outcome variable was the incidence of RD. RD-free time, duration of RD, quality of life, and product safety were also assessed. Results: Seventy patients were included in the study, 35 in the GTA and 35 in the GTE. The incidence of RD was lower in the GTA (71.4%) than in the GTE (91.4%) after 4 weeks of follow-up (RR = 0.78; NNT = 5; p < 0.031). The Skindex-29 questionnaire showed differences in the statement: "My skin condition makes it hard to work or do hobbies" (17.1% in the GTE vs. 2.9% in GTA; p = 0.024). Conclusions: The higher efficacy of Alantel® compared to the control cream in reducing the incidence of RD in women with breast cancer has been demonstrated.

Tunable, multifunctional opto-electrical response in multilayer FePS3/single-layer MoS2 van der Waals p-n heterojunctions.

The combination of specific van der Waals semiconductors in vertical stacks leads to atomically sharp heterointerfaces with unique properties, offering versatility and additional functionality for thin, flexible, optoelectronic devices. In this work, we demonstrate heterostructures built from single-layer MoS2 (n-type) and multilayer FePS3 (p-type) as multifunctional p-n junctions where robust photoluminescent light emission and broadband electrical photo-response coexist. This is made possible by the inherent properties of the materials involved and the precise energy band alignment at their interface, which preserves the photoluminescent emission provided by the single-layer MoS2 and confers exceptional tunability to the system. Indeed, through small changes in the applied voltage across the junction, the interplay between photoluminescence and photocurrent generation can be tuned, allowing for a precise control of the light emission of single-layer MoS2 - from severely quenched to an order of magnitude enhancement. Additionally, the broadband photo-response of the system presents an enhanced performance under ultraviolet illumination, in contrast to other van der Waals heterostacks containing single-layer semiconductors. Furthermore, this photo-response can be adjusted by the application of an external electric field, enabling photocurrent generation under both reverse and forward bias, thereby contributing to the overall functionality and versatility of the system.

Medication delivery errors in outpatients with percutaneous endoscopic gastrostomy: effect on tube feeding replacement.

Patients with enteral access usually receive oral drugs via feeding tubes and correct drug administration remains a challenge. The aim of this study was to identify common medication delivery errors (MDEs) in outpatients with percutaneous endoscopic gastrostomy (PEG) and evaluate their association with the need for tube replacement due to deterioration or clogging. A 2-year retrospective study that comprised adult outpatients with a placed/replaced PEG tube and whose electronic medical record included home medication was carried out. Treatment with medication that should not be crushed and administered through an enteral feeding tube was considered an MDE. We included 269 patients and 213 MDEs (20% of oral prescriptions) were detected in 159. Ninety-two percent of the medications associated with MDEs could be substituted by appropriate formulations. Tube replacement due to obstruction was needed in 85 patients. MDEs were associated with increased risk for tube replacement (OR 2.17; 95% CI 1.10-4.27). Omeprazole enteric-coated capsules were associated with the greatest risk (OR 2.24; 95% CI 1.01-4.93). PEG outpatients are highly exposed to MDEs, leading to a significant increase in the odds of tube replacement, mainly when treated with omeprazole. The use of appropriate alternative therapies would prevent unnecessary adverse events.

Large Biaxial Compressive Strain Tuning of Neutral and Charged Excitons in Single-Layer Transition Metal Dichalcogenides.

The absorption and emission of light in single-layer transition metal dichalcogenides are governed by the formation of excitonic quasiparticles. Strain provides a powerful technique to tune the optoelectronic properties of two-dimensional materials and thus to adjust their exciton energies. The effects of large compressive strain in the optical spectrum of two-dimensional (2D) semiconductors remain rather unexplored compared to those of tensile strain, mainly due to experimental constraints. Here, we induced large, uniform, biaxial compressive strain (∼1.2%) by cooling, down to 10 K, single-layer WS2, MoS2, WSe2, and MoSe2 deposited on polycarbonate substrates. We observed a significant strain-induced modulation of neutral exciton energies, with blue shifts up to 160 meV, larger than in any previous experiments. Our results indicate a remarkably efficient transfer of compressive strain, demonstrated by gauge factor values exceeding previous results and approaching theoretical expectations. At low temperatures, we investigated the effect of compressive strain on the resonances associated with the formation of charged excitons. In WS2, a notable reduction of gauge factors for charged compared to neutral excitons suggests an increase in their binding energy, which likely results from the effects of strain added to the influence of the polymeric substrate.

Mechanisms for the interaction of the milk fat globule membrane with the plasma membrane of gut epithelial cells.

The milk fat globule membrane (MFGM) provides infants and adults with several health benefits. These are not derived solely from its unique composition, but also from arrangement of lipids in the MFGM that, in the case of newborns, could reach the intestine partially intact. Fluorochromes associated with lipid derivatives were used to prove a fusion process between the MFGM and the cellular membrane of differentiated Caco-2 cells. To explore the mechanism of this interaction, incubations of MFGM with Caco-2 cells were carried out in the presence of fusogenic agents or compounds that block other MFGM interaction pathways with cells. Confocal fluorescence microscopy provided visual evidence of the fusion process. Lastly, determination on the lipid profile of cells after their interaction with MFGM indicated a metabolic rearrangement of lipids leading to accumulation of triacylglycerols.

UV- and visible-light photocatalysis using Ni-Co bimetallic and monometallic hydrotalcite-like materials for enhanced CO2 methanation in sabatier reaction.

The CO2 catalytic reduction activities of four different Co-modified Ni-based catalysts derived from hydrotalcite-like materials (HTCs) prepared by co-precipitation method were investigated under thermal and photocatalytic conditions. All catalysts were tested from 473 to 723 K at 10 bar (abs). The light intensity for photocatalytic reactions was 2.4 W cm-2. The samples were characterized to determine the effect of morphological and physicochemical properties of mono-bimetallic active phases on their methanation activity. The activity toward CO2 methanation followed the next order: Ni > Co-Ni > Co. For the monometallic Ni catalyst an increase of a 72% was achieved in the photo-catalytic activity under UV and vis light irradiation at temperatures lower by > 100 K than those in a conventional reaction. Co-modified Ni based hydrotalcite catalysts performed with stability and no deactivation for the 16 h studied under visible light for methanation at 523 K due to the presence of basic sites.

Evaluación del estado nutricional en la enfermedad de Alzheimer y su influencia en la progresión tras el diagnóstico / Nutritional status assessment in Alzheimer disease and its influence on disease progression

Introducción: Las deficiencias nutricionales son frecuentes en la enfermedad de Alzheimer (EA), incluso en fases iniciales. El deterioro nutricional (DN) puede asociarse con una progresión más rápida de la enfermedad. El objetivo fue describir la frecuencia y los factores de riesgo asociados a DN en el momento del diagnóstico y analizar su influencia en la evolución posterior.MétodosEstudio observacional, multicéntrico, prospectivo. Se incluyeron sujetos recién diagnosticados de EA prodrómica (EAp) o demencia por EA (EAd). Se realizaron dos evaluaciones en un periodo de 18 meses. Para estimar el estado nutricional se empleó el Mini Nutritional Assessment Test (MNA, rango 0-30; DN: MNA < 24). El criterio de progresión fue un incremento en la Clinical Dementia Rating-sum of boxes ≥ 3.ResultadosSe incluyeron 50 sujetos con EAp (edad 76,1 ± 5,3 años; 68% mujeres) y 127 con EAd (edad 80 ± 5,9 años; 72,4% mujeres); 141 (79,7%) completaron las dos evaluaciones. La prevalencia de DN fue del 28,2% (EAp 24%, EAd 29,9%; p = 0,43), la mayoría (92%) en riesgo de desnutrición. El DN se asoció con el sexo femenino (OR: 4,2; IC 95%: 1,7-10,5; p < 0,001) y mayor afectación conductual (OR: 5,8; IC 95%: 2,6-12,7; p < 0,001). Se observó mayor proporción de sujetos con progresión entre los que tenían un DN respecto a estado nutricional normal (50% vs 28,7%, p < 0,05; EAd 53,6% vs 31,8%, p < 0,05; EAp 41,7% vs 22,9%; p = 0,21). Una mayor afectación cognitiva (OR: 2,1; IC 95%: 1,03-4,4; p < 0,05) y un DN (OR: 2,4; IC 95%: 1,1-5,1; p < 0,05) fueron factores de riesgo independientes de progresión.ConclusionesLa prevalencia de DN en la EA es elevada. La evaluación del estado nutricional en el momento del diagnóstico puede permitir identificar pacientes con mayor riesgo de progresión de la enfermedad. (AU)

Introduction: Nutritional deficiencies are frequent in Alzheimer disease (AD), even in early stages. Nutritional impairment (NI) may be associated with faster disease progression. The objective of this study was to describe the frequency of NI and the associated risk factors at the time of diagnosis and to analyse its influence on subsequent progression.MethodsWe performed a prospective, multicentre, observational study of patients recently diagnosed with prodromal AD (pAD) or dementia due to AD (ADd). Two clinical assessments were conducted over a period of 18 months. The Mini Nutritional Assessment test (MNA; score range, 0-30; cut-off point for NI, < 24) was used to estimate nutritional status. Progression was defined as an increase of ≥ 3 points on the Clinical Dementia Rating-sum of boxes test.ResultsThe sample included 50 patients with pAD (mean [standard deviation] age, 76.1 [5.3] years; 68% women), and 127 with ADd (80 [5.9] years; 72.4% women). A total of 141 (79.7%) completed both evaluations. The prevalence of NI was 28.2% (24% for pAD, 29.9% for ADd; P = .43), with the majority (92%) at risk of malnutrition. NI was associated with female sex (odds ratio [OR]: 4.2; 95% confidence interval [CI]: 1.7-10.5; P < .001) and greater behavioural involvement (OR: 5.8; 95% CI: 2.6-12.7; P < .001). A larger proportion of patients with progression was observed among those with NI than among those with normal nutritional status (50% vs 28.7%, P < .05; ADd: 53.6% vs 31.8%, P < .05; pAD: 41.7% vs 22.9%, P = .21). Greater cognitive impairment (OR: 2.1; 95% CI: 1.03-4.4; P < .05) and NI (OR: 2.4; 95% CI: 1.1-5.1; P < .05) were independent risk factors for disease progression.ConclusionsNI is highly prevalent in patients with AD. Assessing nutritional status at the time of diagnosis may enable identification of patients at greater risk of disease progression. (AU)

Physiologically-based pharmacokinetic modelling and dosing evaluation of gentamicin in neonates using PhysPK.

Each year, infections caused around the 25% of neonatal deaths. Early empirical treatments help to reduce this mortality, although optimized dosing regimens are still lacking. The aims were to develop and validate a gentamicin physiologically-based pharmacokinetic (PBPK) model and then potentially explore dosing regimens in neonates using pharmacokinetic and pharmacodynamic criteria. The PBPK model developed consisted of 2 flow-limited tissues: kidney and other tissues. It has been implemented on a new tool called PhysPK, which allows structure reusability and evolution as predictive engine in Model-Informed Precision Dosing (MIPD). Retrospective pharmacokinetic information based on serum levels data from 47 neonates with gestational age between 32 and 39 weeks and younger than one-week postnatal age were used for model validation. The minimal PBPK model developed adequately described the gentamicin serum concentration-time profile with an average fold error nearly 1. Extended interval gentamicin dosing regimens (6 mg/kg q36h and 6 mg/kg q48h for term and preterm neonates, respectively) showed efficacy higher than 99% with toxicity lower than 10% through Monte Carlo simulation evaluations. The gentamicin minimal PBPK model developed in PhysPK from literature information, and validated in preterm and term neonates, presents adequate predictive performance and could be useful for MIPD strategies in neonates.

Photoluminescence Enhancement by Band Alignment Engineering in MoS2/FePS3 van der Waals Heterostructures.

Single-layer semiconducting transition metal dichalcogenides (2H-TMDs) display robust excitonic photoluminescence emission, which can be improved by controlled changes to the environment and the chemical potential of the material. However, a drastic emission quench has been generally observed when TMDs are stacked in van der Waals heterostructures, which often favor the nonradiative recombination of photocarriers. Herein, we achieve an enhancement of the photoluminescence of single-layer MoS2 on top of van der Waals FePS3. The optimal energy band alignment of this heterostructure preserves light emission of MoS2 against nonradiative interlayer recombination processes and favors the charge transfer from MoS2, an n-type semiconductor, to FePS3, a p-type narrow-gap semiconductor. The strong depletion of carriers in the MoS2 layer is evidenced by a dramatic increase in the spectral weight of neutral excitons, which is strongly modulated by the thickness of the FePS3 underneath, leading to the increase of photoluminescence intensity. The present results demonstrate the potential for the rational design of van der Waals heterostructures with advanced optoelectronic properties.

Moral distress among healthcare professionals working in intensive care units in Spain / Desasosiego moral entre los profesionales sanitarios que trabajan en unidades de cuidados intensivos en España

Objective To assess moral distress (MD) among Spanish critical care healthcare professionals (HCPs). Design Cross-sectional, prospective study. Setting ICUs in Spain. Participants HCPs currently working in Spanish ICUs. Interventions A 55-item questionnaire was electronically distributed. Main variables The questionnaire included work-related and socio-demographic characteristics, the Spanish version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA), and the Hospital Ethical Climate Survey (HECS). Results In total, 1065 intensive care providers completed the questionnaire. Three out of four validity hypotheses were supported. MD was significantly higher for physicians (80, IQR 40–135) than for nurses (61, IQR 35–133, p=0.026). MD was significantly higher for those clinicians considering leaving their position (78, IQR 46–163 vs. 61, IQR 32–117; p<0.001). The MMD-HP-SPA was inversely correlated with the HECS (r=−0.277, p<0.001). An exploratory factor analysis revealed a four-factor structure, evidencing the patient, team, and system levels of MD. Conclusions In the study sample, Spanish intensivists report higher MD than nurses. Strategies to improve ICU ethical climate and to correct other related factors in order to mitigate MD at a patient, team, and system level should be implemented. Both groups of HCPs manifest a relevant intention to leave their position due to MD. Further studies are needed to determine the extent to which MD influences their desire to leave the job (AU)

Objetivo Evaluar el desasosiego moral (DM) entre los profesionales sanitarios que trabajan en UCI en España. Diseño Estudio prospectivo transversal. Ámbito UCI en España. Participantes Profesionales sanitarios que actualmente trabajan en UCI españolas. Intervenciones Se distribuyó electrónicamente un cuestionario de 55 ítems. Variables principales El cuestionario incluía características sociodemográficas y laborales, la versión en español de la Medida de desasosiego moral para profesionales sanitarios (MMD-HP-SPA) y la Encuesta de clima ético hospitalario (HECS). Resultados En total 1.065 profesionales sanitarios de cuidados intensivos completaron el cuestionario. Tres de 4 hipótesis de validez fueron apoyadas. El DM fue significativamente mayor entre los médicos (80, IQR 40-135) que entre las enfermeras (61, IQR 35-133, p=0,026). El DM fue significativamente más alto para aquellos médicos que estaban considerando dejar su puesto de trabajo (78, IQR 46-163 vs. 61, IQR 32-117; p<0,001). El MMD-HP-SPA se correlacionó inversamente con el HECS (r=–0,277, p<0,001). Un análisis factorial exploratorio reveló una estructura de 4 factores, evidenciando los niveles de paciente, equipo y sistema del DM. Conclusiones En este estudio los intensivistas refirieron niveles de DM más altos que las enfermeras. Se deben implementar estrategias para mejorar el clima ético en las UCI y corregir otros factores relacionados con el fin de mitigar el DM en lo que atañe al paciente, al equipo y al sistema. Ambos grupos de profesionales manifestaron una intención relevante de abandonar su puesto de trabajo debido al DM. Se necesitan más estudios para determinar en qué medida el DM influye sobre su deseo de abandonar su puesto de trabajo (AU)

Moral distress among healthcare professionals working in intensive care units in Spain.

OBJECTIVE: To assess moral distress (MD) among Spanish critical care healthcare professionals (HCPs). DESIGN: Cross-sectional, prospective study. SETTING: ICUs in Spain. PARTICIPANTS: HCPs currently working in Spanish ICUs. INTERVENTIONS: A 55-item questionnaire was electronically distributed. MAIN VARIABLES: The questionnaire included work-related and socio-demographic characteristics, the Spanish version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA), and the Hospital Ethical Climate Survey (HECS). RESULTS: In total, 1065 intensive care providers completed the questionnaire. Three out of four validity hypotheses were supported. MD was significantly higher for physicians (80, IQR 40-135) than for nurses (61, IQR 35-133, p=0.026). MD was significantly higher for those clinicians considering leaving their position (78, IQR 46-163 vs. 61, IQR 32-117; p<0.001). The MMD-HP-SPA was inversely correlated with the HECS (r=-0.277, p<0.001). An exploratory factor analysis revealed a four-factor structure, evidencing the patient, team, and system levels of MD. CONCLUSIONS: In the study sample, Spanish intensivists report higher MD than nurses. Strategies to improve ICU ethical climate and to correct other related factors in order to mitigate MD at a patient, team, and system level should be implemented. Both groups of HCPs manifest a relevant intention to leave their position due to MD. Further studies are needed to determine the extent to which MD influences their desire to leave the job.

Electrocardiograma y evaluación predeportiva en el niño que practica deporte / Electrocardiogram and pre-sports evaluation in the child who practices sports

Introducción: existe consenso en la necesidad de realizar un cribado predeportivo, aunque con enormes diferencias en cuanto a protocolos. El objetivo de nuestro estudio es conocer el estado de los reconocimientos predeportivos en niños, conocer la prevalencia de anomalías cardiovasculares y valorar la utilidad del electrocardiograma (ECG). Pacientes y métodos: estudio descriptivo transversal. Durante dos años se realizó el reconocimiento médico propuesto por la Guía Clínica de Evaluación Cardiovascular previa a la práctica deportiva en Pediatría en las revisiones de niños mayores de seis años, incluyendo anamnesis, exploración física y electrocardiograma. Resultados: se incluyeron 691 niños. El 62,5% realizaba deporte extraescolar con una mediana de 3 horas por semana (2-4,5). El 52,2% de los niños estaban federados. Existen diferencias en las horas de práctica deportiva y la edad entre niños federados y no federados (p <0,001). En los federados se realizó reconocimiento en el 68,1% y un ECG en el 19%, existiendo diferencias significativas entre los distintos tipos de deportes (p <0,001). El 13% de los niños estudiados presentaban antecedentes familiares de cardiopatía. El 3,5% de los ECG realizados fueron patológicos precisando valoración por Cardiología Pediátrica. El 6,6% de los niños con antecedentes familiares de cardiopatía y el 3% de los niños sin antecedentes necesitaron seguimiento cardiológico. Conclusiones: en la mayoría de los reconocimientos deportivos de nuestro medio no se incluye ECG. Investigar en profundidad los antecedentes familiares de cardiopatía es importante (AU)

Introduction: there is consensus on the need to perform pre-sport screening, although with enormous differences in terms of protocols. The objective of our study is to know the status of pre-sport screenings in children, to know the prevalence of cardiovascular abnormalities and to assess the usefulness of the electrocardiogram (ECG).Patients and methods: descriptive cross-sectional study. For two years, the medical screening proposed by the Clinical Guide for Cardiovascular Evaluation prior to sports practice in pediatrics was carried out in the check-ups of children older than 6 years, including anamnesis, physical examination and electrocardiogram.Results: 691 children were included. 62.5% did extracurricular sports with a median of 3 hours per week (2-4.5). 52.2% of the children were federated. There are differences in the hours of sports practice and age between federated and non-federated children (p <0.001). In federated, recognition was performed in 68.1% and ECG in 19%, with significant differences between the different types of sports (p <0.001). 13% of the children studied had a family history of heart disease. 3.5% of the ECGs performed were pathological, requiring evaluation by pediatric cardiology. 6.6% of the children with a family history of heart disease and 3% of the children without a history required cardiac follow-up.Conclusions: ECG is not included in most of the sports examinations in our environment. Investigating family history of heart disease is important. (AU)