NLRP3 Contributes to Sarcopenia Associated to Dependency Recapitulating Inflammatory-Associated Muscle Degeneration.

Sarcopenia, a complex and debilitating condition characterized by progressive deterioration of skeletal muscle, is the primary cause of age-associated disability and significantly impacts healthspan in elderly patients. Despite its prevalence among the aging population, the underlying molecular mechanisms are still under investigation. The NLRP3 inflammasome is crucial in the innate immune response and has a significant impact on diseases related to inflammation and aging. Here, we investigated the expression of the NLRP3 inflammasome pathway and pro-inflammatory cytokines in skeletal muscle and peripheral blood of dependent and independent patients who underwent hip surgery. Patients were categorized into independent and dependent individuals based on their Barthel Index. The expression of NLRP3 inflammasome components was significantly upregulated in sarcopenic muscle from dependent patients, accompanied by higher levels of Caspase-1, IL-1ß and IL-6. Among older dependent individuals with sarcopenia, there was a significant increase in the MYH3/MYH2 ratio, indicating a transcriptional shift in expression from mature to developmental myosin isoforms. Creatine kinase levels and senescence markers were also higher in dependent patients, altogether resembling dystrophic diseases and indicating muscle degeneration. In summary, we present evidence for the involvement of the NLRP3/ASC/NEK7/Caspase-1 inflammasome pathway with activation of pro-inflammatory SASP in the outcome of sarcopenia in the elderly.

Functional continuum: independent predictor of one-year mortality and key decision-making element in older adults with severe aortic stenosis amenable to aortic valve replacement.

OBJECTIVES: The impact of functional capacity over the entire functional continuum in older adults undergoing aortic valve replacement (AVR) has not been studied to date. This study aims to analyze 1.- the distribution of a cohort of older adults presenting severe aortic stenosis (AS) amenable to AVR in the different categories of the Functional Continuum Scale (FCS); 2.- its association with decision-making regarding valve disease; and 3.- its impact upon the one-year mortality rate of surgical (SAVR), transcatheter (TAVR) aortic valve replacement, or the decision to provide conservative management (OMT). METHODS: This prospective study included patients from the FRESAS (FRailty-Evaluation-in-Severe-Aortic-Stenosis) registry evaluated by the reference Heart-Team of a region in northern Spain. All the patients underwent comprehensive geriatric assessment. RESULTS: The study comprised 257 patients aged 84.0 ± 3.9 years. MANAGEMENT: SAVR: 25.3%, TAVR: 58.0% and OMT: 16.7%. Increased patient functional capacity was associated with an increased tendency to perform more invasive valve disease treatment. The overall one-year survival rate was 81.3%. One-year all-cause mortality: FCS-1 to FCS-2 "robust" 11.5%, FCS-3 to FCS-4 "prefrail" 14.7%, FCS-5 "frail" 19.2% and FCS-6 to FCS-8 "dependent" 45.0%; p < 0.001. Adjusted mortality analysis: FCS with HR = 1.206 [95%CI, 0.999-1.451 (p = 0.051)]; EuroSCORE-II with HR = 1.071 [95%CI, 1.006-1.161 (p = 0.033)]; and OMT with HR = 2.840 [95%CI, 1.409-5.772 (p = 0.004)] were retained in the final multivariable logistic regression model. CONCLUSIONS: In older AS patients amenable to AVR, the FCS is a useful predictive tool that may aid clinical decision-making.

Phenotypic characterization of X-linked hypophosphatemia in pediatric Spanish population.

BACKGROUND: X-linked hypophosphatemia (XLH) is a hereditary rare disease caused by loss-of-function mutations in PHEX gene leading tohypophosphatemia and high renal loss of phosphate. Rickets and growth retardation are the major manifestations of XLH in children, but there is a broad phenotypic variability. Few publications have reported large series of patients. Current data on the clinical spectrum of the disease, the correlation with the underlying gene mutations, and the long-term outcome of patients on conventional treatment are needed, particularly because of the recent availability of new specific medications to treat XLH. RESULTS: The RenalTube database was used to retrospectively analyze 48 Spanish patients (15 men) from 39 different families, ranging from 3 months to 8 years and 2 months of age at the time of diagnosis (median age of 2.0 years), and with XLH confirmed by genetic analysis. Bone deformities, radiological signs of active rickets and growth retardation were the most common findings at diagnosis. Mean (± SEM) height was - 1.89 ± 0.19 SDS and 55% (22/40) of patients had height SDS below-2. All cases had hypophosphatemia, serum phosphate being - 2.81 ± 0.11 SDS. Clinical manifestations and severity of the disease were similar in both genders. No genotype-phenotype correlation was found. Conventional treatment did not attenuate growth retardation after a median follow up of 7.42 years (IQR = 11.26; n = 26 patients) and failed to normalize serum concentrations of phosphate. Eleven patients had mild hyperparathyroidism and 8 patients nephrocalcinosis. CONCLUSIONS: This study shows that growth retardation and rickets were the most prevalent clinical manifestations at diagnosis in a large series of Spanish pediatric patients with XLH confirmed by mutations in the PHEX gene. Traditional treatment with phosphate and vitamin D supplements did not improve height or corrected hypophosphatemia and was associated with a risk of hyperparathyroidism and nephrocalcinosis. The severity of the disease was similar in males and females.

Management of a Penetrating Orbital Trauma from an Unusual Foreign Body with Associated Eye Injury.

The aim of this article is to describe the principles that should guide the management of an orbital trauma with ocular injury through an updated review of the literature and the study of a clinical case involving an 80-year-old woman who presented with a penetrating orbital wound due to a wooden foreign body with a closed ocular trauma. Satisfactory and stable results over time are determined by systematically analyzing and evaluating each aspect of the case following a surgical strategy based on the most current protocols.

Risk of cardiovascular involvement in pediatric patients with X-linked hypophosphatemia.

OBJECTIVE: To find out if cardiovascular alterations are present in pediatric patients with X-linked hypophosphatemia (XLH). STUDY DESIGN: Multicentre prospective clinical study on pediatric patients included in the RenalTube database ( www.renaltube.com ) with genetically confirmed diagnosis of XLH by mutations in the PHEX gene. The study's protocol consisted of biochemical work-up, 24-h ambulatory blood pressure monitoring (ABPM), carotid ultrasonography, and echocardiogram. All patients were on chronic treatment with phosphate supplements and 1-hydroxy vitamin D metabolites. RESULTS: Twenty-four patients (17 females, from 1 to 17 years of age) were studied. Serum concentrations (X ± SD) of phosphate and intact parathyroid hormone were 2.66 ± 0.60 mg/dl and 58.3 ± 26.8 pg/ml, respectively. Serum fibroblast growth factor 23 (FGF23) concentration was 278.18 ± 294.45 pg/ml (normal < 60 pg/ml). Abnormally high carotid intima media thickness was found in one patient, who was obese and hypertensive as revealed by ABPM, which disclosed arterial hypertension in two other patients. Z scores for echocardiographic interventricular septum end diastole and left ventricular posterior wall end diastole were + 0.77 ± 0.77 and + 0.94 ± 0.86, respectively. Left ventricular mass index (LVMI) was 44.93 ± 19.18 g/m2.7, and four patients, in addition to the obese one, had values greater than 51 g/m2.7, indicative of left ventricular hypertrophy. There was no correlation between these echocardiographic parameters and serum FGF23 concentrations. CONCLUSIONS: XLH pediatric patients receiving conventional treatment have echocardiographic measurements of ventricular mass within normal reference values, but above the mean, and 18% have LVMI suggestive of left ventricular hypertrophy without correlation with serum FGF23 concentrations. This might indicate an increased risk of cardiovascular involvement in XLH.

Enuresis secundaria como presentación de feocromocitoma en una niña de 13 años / Pheochromocytoma presenting with secondary enuresis in a 13-year-old girl

El feocromocitoma es un tumor raro, infrecuente en la edad pediátrica. Los síntomas clásicos derivados del exceso de catecolaminas son cefalea, sudoración y palpitaciones, aunque los niños pueden tener una clínica más atípica. La hipertensión arterial suele ser un signo constante en la mayoría de los pacientes. Existen pocos casos descritos de poliuria como forma de presentación de feocromocitoma. Se presenta el caso de una niña de 13 años remitida a consulta de Nefrología Pediátrica por enuresis secundaria de un año de evolución. La tensión arterial clínica tomada durante la exploración era superior al percentil 99 para su edad y talla, motivo por el que se decidió el ingreso para su estudio y tratamiento.

Pheochromocytoma is a rare tumor which is infrequent in children. Although the clinical presentation in children can be atypical, the classic symptoms are headache, sweating and tachycardia. Hypertension is often a constant sign in most patients. There are few cases in literature reporting pheochromocytoma presented with polyuria. We present a 13-year-old girl who came to the Pediatric Nephrologist due to a year of evolution of secondary enuresis. When her blood pressure was taken, she was above the 99th percentile that corresponds to her age and her height that is why she was admitted for treatment and diagnostic study.

[Pheochromocytoma presenting with secondary enuresis in a 13-year-old girl]. / Enuresis secundaria como presentación de feocromocitoma en una niña de 13 años.

Pheochromocytoma is a rare tumor which is infrequent in children. Although the clinical presentation in children can be atypical, the classic symptoms are headache, sweating and tachycardia. Hypertension is often a constant sign in most patients. There are few cases in literature reporting pheochromocytoma presented with polyuria. We present a 13-year-old girl who came to the Pediatric Nephrologist due to a year of evolution of secondary enuresis. When her blood pressure was taken, she was above the 99th percentile that corresponds to her age and her height that is why she was admitted for treatment and diagnostic study.

El feocromocitoma es un tumor raro, infrecuente en la edad pediátrica. Los síntomas clásicos derivados del exceso de catecolaminas son cefalea, sudoración y palpitaciones, aunque los niños pueden tener una clínica más atípica. La hipertensión arterial suele ser un signo constante en la mayoría de los pacientes. Existen pocos casos descritos de poliuria como forma de presentación de feocromocitoma. Se presenta el caso de una niña de 13 años remitida a consulta de Nefrología Pediátrica por enuresis secundaria de un año de evolución. La tensión arterial clínica tomada durante la exploración era superior al percentil 99 para su edad y talla, motivo por el que se decidió el ingreso para su estudio y tratamiento.

Triplet Mediated C-N Dissociation versus Internal Conversion in Electronically Excited N-Methylpyrrole.

The photochemical and photophysical pathways operative in N-methylpyrrole, after excitation in the near part of its ultraviolet absorption spectrum, have been investigated by the combination of time-resolved total ion yield and photoelectron spectroscopies with high-level ab initio calculations. The results collected are remarkably different from the observations made for pyrrole and other aromatic systems, whose dynamics is dictated by the presence of πσ* excitations on X-H (X: N, O, S, ...) bonds. The presence of a barrier along the C-N dissociation coordinate that can not be tunneled triggers two alternative decay mechanisms for the S1 A″ πσ* state. While at low vibrational content the C-N dissociation occurs on the surface of a lower (3)ππ* state reached after efficient intersystem crossing, at higher excitation energies, the A″ πσ* directly internally converts to the ground state through a ring-twisted S1/S0 conical intersection. The findings explain previous observations on the molecule and may be relevant for more complex systems containing similar C-N bonds, such as the DNA nucleotides.

Tracking the relaxation of 2,5-dimethylpyrrole by femtosecond time-resolved photoelectron and photoion detection.

The relaxation of 2,5-dimethylpyrrole after excitation in the 290-239 nm range, which covers the weak absorption of the S1 (1)A2 πσ* state, dissociative along the N-H bond, and the stronger band mostly attributed to the (1)B2 ππ* state, has been investigated by time-resolved ion and photoelectron techniques. The measurements yield an invariant lifetime of ∼55 fs for the (1)πσ* state, after preparation in its Franck-Condon region with increasing vibrational content. This ultrafast rate indicates that, contrary to the observations made in pyrrole (Roberts et al. Faraday Discuss. 2013, 163, 95-116), the molecule reaches the dissociative part of the potential without any barrier effect, although calculations predict the latter to be higher than in the pyrrole case. The results are rationalized in terms of a barrier free multidimensional pathway that very likely involves out-of-plane vibrations. Additionally, a lifetime of ∼100 fs is found after excitation along the higher (1)B2 ππ* ← S0 transition. The relaxation of this state by coupling to a very short living S1 (1)πσ* state, or by alternative routes, is discussed in the light of the collected photoelectron measurements.

Revisiting the relaxation dynamics of isolated pyrrole.

Herein, the interpretation of the femtosecond-scale temporal evolution of the pyrrole ion signal, after excitation in the 267-217 nm interval, recently published by our group [R. Montero, A. Peralta Conde, V. Ovejas, M. Fernández-Fernández, F. Castaño, J. R. Vázquez de Aldana, and A. Longarte, J. Chem. Phys. 137, 064317 (2012)] is re-visited. The observation of a shift in the pyrrole(+) transient respect to zero delay reference, initially attributed to ultrafast dynamics on the πσ* type state (3s a1 ← π 1a2), is demonstrated to be caused by the existence of pump + probe populated states, along the ionization process. The influence of these resonances in pump-prone ionization experiments, when multi-photon probes are used, and the significance of a proper zero-time reference, is discussed. The possibility of preparing the πσ* state by direct excitation is investigated by collecting 1 + 1 photoelectron spectra, at excitation wavelengths ranging from 255 to 219 nm. No conclusive evidences of ionization through this state are found.

Ultrafast Nonradiative Relaxation Channels of Tryptophan.

The nonradiative relaxation channels of gas-phase tryptophan excited along the S1-S4 excited states (287-217 nm) have been tracked by femtosecond time-resolved ionization. In the low-energy region, λ ≥ 240 nm, the measured transient signals reflect nonadiabatic interactions between the two bright La and Lb states of ππ* character and the dark dissociative πσ* state of the indole NH. The observed dynamical behavior is interpreted in terms of the ultrafast conversion of the prepared La state, which simultaneously populates the fluorescent Lb> and the dissociative πσ* states. At higher energies, after excitation of the S4 state, the tryptophan dynamics diverges from that observed in indole, pointing to the opening of a relaxation channel that could involve states of the amino acid part. The work provides a detailed picture of the processes and electronic states involved in the relaxation of the molecule, after photoexcitation in the near part of its UV absorption spectrum.

Ultrafast evolution of imidazole after electronic excitation.

The ultrafast dynamics of the imidazole chromophore has been tracked after electronic excitation in the 250-217 nm energy region, by time delayed ionization with 800 nm laser pulses. The time-dependent signals collected at the imidazole(+) mass channel show the signature of femtosecond dynamics, originating on the πσ*- and ππ*-type states located in the explored energy region. The fitting of the transients, which due to the appearance of nonresonant coherent adiabatic excitation requires a quantum treatment based in the Bloch equations, yields two lifetimes of 18 ± 4 and 19 ± 4 fs. The first is associated with the πσ* ← ππ* internal conversion, while the second reflects the loss of ionization cross-section as the system evolves along the dissociative πσ* surface. This study provides a comprehensive picture of the photophysics of the molecule that agrees with previous experimental and theoretical findings.

Femtosecond evolution of the pyrrole molecule excited in the near part of its UV spectrum.

The evolution of the isolated pyrrole molecule has been followed after excitation in the 265-217 nm range by using femtosecond time delayed ionization. The transients collected in the whole excitation range show the vanishing of the ionization signal in the femtosecond time scale, caused by the relaxation along a πσ(∗) type state (3s a(1)←π 1a(2)), which is the lowest excited electronic state of the molecule. This surface is dissociative along the NH bond, yielding a 15 ± 3 fs lifetime that reflects the loss of the ionization cross-section induced by the ultrafast wavepacket motion. Although a weak πσ(∗) absorption is detected, the state is mainly reached through internal conversion of the higher bright ππ(∗) transitions, which occurs with a 19 ± 3 fs lifetime. In addition to its resonant excitation, the intense ππ(∗) absorption extending in the 220-190 nm interval is also out-of-resonance populated at energies far to the red from its absorption onset. This coherent adiabatic excitation of the ππ(∗) transition should follow the excitation pulse (coherent population return effect), but instead the system relaxes toward the lower πσ(∗) surface through a conical intersection during the interaction time, leading to the population of πσ(∗) state at wavelengths as long as 265 nm. According to the observed behavior, the time evolution of the system in the full excitation range studied is modeled by a coherent treatment that provides key insights on the photophysical properties of the molecule.

Valoración del estado de nutrición yódica y niveles de tiroxinemia en mujeres embarazadas de diferentes áreas geográficas de Castilla y León / Assessment of iodine nutritional status and thyroxine levels in pregnant women from different geographic areas of the Castile and Leon

Fundamento y objetivos El estado nutricional de yodo de las embarazadas es importante para el desarrollo neuronal del feto. Esta situación puede ser distinta según la zona geográfica estudiada, por lo que hemos valorado la función tiroidea y la excreción de yodo urinario en gestantes de tres provincias diferentes de una extensa comunidad autónoma. Pacientes y método Estudio descriptivo, llevado a cabo en tres áreas sanitarias de Burgos, zona urbana, Ávila, zona rural y Ponferrada, zona rural valorada previamente. Se estudiaron 1.200 mujeres en el primer trimestre de la gestación, se realizo encuesta, se midieron hormonas tiroideas y contenido de yodo en orina. Resultados Declararon consumir sal yodada el 40% de las embarazadas y compuestos yodados el 17%. La mediana de yoduria del grupo total fue de 121 mcg/L, con concentraciones más bajas de yodo en orina en Burgos (117 mcg/L) y Ponferrada (118 mcg/L) y mejores en Ávila (130 mcg/L). La yoduria fue inferior a 100 mcg/L en el 34% de las gestantes y presentaron niveles indetectables el 3,3%. El 69,8% de las mujeres presentaron yodurias menores de 150 mcg/L. Se constató hipotiroxinemia en un 1,1% de las gestantes y la tirotropina se encontró aumentada en un 4,7%.ConclusionesEn la actualidad existe déficit de yodo en las embarazadas de diferentes zonas de nuestra amplia comunidad autónoma. El consumo de sal yodada y de compuestos farmacológicos de yodo no está ampliamente establecido. Es necesario suplementar el consumo de yodo en las mujeres que programen embarazo y lo antes posible en las que ya se encuentran embarazadas una vez conocida la gestación. Sería conveniente llevar a cabo estudios de otras áreas no valoradas (AU)

Background and objectives: Iodine nutritional status in pregnant women is important for neuronal development of the fetus, and may vary depending on the geographic area. Thyroid function and urinary iodine excretion were therefore assessed in pregnant women from three different provinces of a large Spanish autonomous community. Patients and methods: A descriptive study was conducted in the three healthcare areas of Burgos, Avila, and Ponferrada on 1,200 women in the first trimester of pregnancy The study consisted of a survey and thyroid hormone and urinary iodine measurements. Results: Use of iodized salt and iodine-containing pharmacological compounds was reported by40% and 17% of pregnant women respectively. Median urinary iodine excretion in the total group was 121 mcg/L, with lower values in Burgos (117 mcg/L) and Ponferrada (118 mcg/L) and higher levels in Avila (130 mcg/L). Urinary iodine excretion was less than 100 mcg/L in 34% of women and was undetectable in 3.3%. Excretion levels lower than 150 mcg/L were found in 69.8% of women. Low thyroxine levels were detected in 1.1%, and thyrotropin levels were increased in4.7%.Conclusions: Iodine deficiency currently exists in pregnant women from different areas of ourlarge autonomous community. Consumption of iodized salt and iodine-containing pharmacologicalcompounds is not widely established. It would be of great interest to conduct studies in other geographic areas and to advise an increased iodine intake in women who plan to become pregnant and in pregnant women from the very start of pregnancy (AU)

[Assessment of iodine nutritional status and thyroxine levels in pregnant women from different geographic areas of the Castile and Leon]. / Valoración del estado de nutrición yódica y niveles de tiroxinemia en mujeres embarazadas de diferentes áreas geográficas de Castilla y León.

BACKGROUND AND OBJECTIVES: Iodine nutritional status in pregnant women is important for neuronal development of the fetus, and may vary depending on the geographic area. Thyroid function and urinary iodine excretion were therefore assessed in pregnant women from three different provinces of a large Spanish autonomous community. PATIENTS AND METHODS: A descriptive study was conducted in the three healthcare areas of Burgos, Avila, and Ponferrada on 1,200 women in the first trimester of pregnancy The study consisted of a survey and thyroid hormone and urinary iodine measurements. RESULTS: Use of iodized salt and iodine-containing pharmacological compounds was reported by 40% and 17% of pregnant women respectively. Median urinary iodine excretion in the total group was 121 mcg/L, with lower values in Burgos (117 mcg/L) and Ponferrada (118 mcg/L) and higher levels in Avila (130 mcg/L). Urinary iodine excretion was less than 100 mcg/L in 34% of women and was undetectable in 3.3%. Excretion levels lower than 150 mcg/L were found in 69.8% of women. Low thyroxine levels were detected in 1.1%, and thyrotropin levels were increased in 4.7%. CONCLUSIONS: Iodine deficiency currently exists in pregnant women from different areas of our large autonomous community. Consumption of iodized salt and iodine-containing pharmacological compounds is not widely established. It would be of great interest to conduct studies in other geographic areas and to advise an increased iodine intake in women who plan to become pregnant and in pregnant women from the very start of pregnancy.

B-scan ultrasonography to screen for retinal tears in acute symptomatic age-related posterior vitreous detachment.

OBJECTIVE: To evaluate the performance characteristics of B-scan ultrasonography (US) as a diagnostic test for the detection of retinal tears in acute symptomatic age-related posterior vitreous detachment (PVD). DESIGN: Evaluation of a diagnostic test through a cross-sectional study with prospective data collection. The study intended to meet the 14 items proposed by the Quality Assessment of Diagnostic Accuracy Studies panel. PARTICIPANTS: Two hundred thirty-nine patients with acute-onset age-related PVD were consecutively enrolled in a nonreferral hospital. TESTING: Comprehensive eye examination including vitreous and retinal biomicroscopy was performed on an emergency basis followed by blind B-scan kinetic US. Sensitivity, specificity and predictive values of the index test (B-scan US) were analyzed and compared with the standard reference (baseline examination). In cases of disagreement between both diagnostic methods, a new gold standard was established based on the findings of subsequent directed indirect ophthalmoscopy based on the echographic findings. Positive and negative likelihood ratios and a likelihood nomogram with pretest and posttest odds of retinal tears were calculated for B-scan US. MAIN OUTCOME MEASURES: Index test performance for the detection of retinal tears secondary to age-related PVD. RESULTS: Both diagnostic methods performed comparably. The sensitivity of B-scan US for detection of retinal tears was 96% and that of baseline examination was 89%. Both methods had similar negative predictive values of 99%. B-scan US specificity was 98%. The estimated pretest and posttest probability for a positive B-scan US were 10.8% and 89%, respectively. CONCLUSIONS: Proper B-scan kinetic US is a noninvasive and accurate diagnostic method for the detection of retinal tears that can be reliably used in no view or small pupil cases with symptomatic PVD. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.