Practical Requirements for the Development of an Advanced Cardiorenal Unit.

BACKGROUND: Heart failure is frequently associated with kidney disease, and patients with kidney disease are at increased risk of heart failure. The co-occurrence of both entities not only significantly increases morbidity and mortality but also complicates therapy. SUMMARY: Cardiorenal syndrome often requires a broad, comprehensive, and multidisciplinary approach. As a result, a need has arisen to create specialized cardiorenal units that allow for rigorous and personalized management of this condition. Moreover, in some cases, cardiorenal syndrome is more complex, owing to an acute and critical situation that requires the concept of the cardiorenal unit to be extended toward advanced diagnostic and therapeutic positions, thus confirming the need for an advanced cardiorenal unit. The creation of these units constitutes a real challenge, necessitating a specific multilevel action plan, covering governance and management, type of patient, personnel requirements, service portfolio, care process, information systems, and other resources. Specific lines of action must be proposed for each of the relevant points in order to facilitate development of these units, together with continuous evaluation of unit activity through specific indicators, and to detect areas for improvement. KEY MESSAGES: This study addresses the conditions and organizational characteristics that enable the creation, development, and continuous improvement of advanced cardiorenal units.

Rezago en desarrollo infantil temprano en México: un análisis de la desigualdad.

OBJETIVO: Estimar la desigualdad en el rezago de desarrollo infantil temprano (DIT) en la niñez de 24 a 59 meses. Material y métodos. Se evaluó el DIT mediante el índice de desarrollo infantil temprano 2030. Se estimaron los factores asociados con el rezago de DIT y su índice de concentración (IC), además de su descomposición para estimar la desigualdad entre los factores. RESULTADOS: La desigualdad se concentró más en la niñez con menor nivel de bienestar (IC= -0.09, p<0.01), con peores niveles en estados con marginación muy alta (-0.28, valor-p <0.01) y muy baja (-0.15, valor- p= 0.03). Los factores que más contribuyen a esta desigualdad son falta de acceso a libros y de apoyo al aprendizaje, además de residencia en municipios de alta marginación. Conclusión. Las políticas públicas deben enfocarse en priorizar a la niñez en riesgo de no lograr su máximo DIT, facilitar el acceso a oportunidades de aprendizaje y a libros infantiles.

Adolescent use of outpatient health services in Mexico: their health needs and associated factors.

OBJECTIVE: To estimate adolescent use of outpatient services, identifying their health needs and associated socioeconomic factors. MATERIALS AND METHODS: Using data from Ensanut 2018-2019, adolescents (ages 10-19) with health needs and those receiving care from health personnel (users) were identified. Needs were analyzed by sex and socioeconomic status (SES). Logistic models were used to assess the factors associated with the use of health care and choice of provider. RESULTS: 6% of adolescents reported health needs, of whom 64% used outpatient services. Respiratory and gastrointestinal infections were the principal health needs prompting use of services overall. However, by SES, motivations centered on pregnancy for the poor and accidental injuries for the wealthy. One in three adolescents with health needs, particularly the poorest, received no care. Living with a partner and having health insurance were the main predictors of use. Greater schooling among household heads and higher SES correlated with the use of private services. CONCLUSIONS: Despite being aware of their health needs, adolescents are the group that uses health services the least in Mexico. Promoting preventative and timely treatment for this population would encourage youths to seek care more often.

Transcriptomic signature of bacteria exposed to benzalkonium chloride.

The COVID-19 pandemic has highlighted our reliance on biocides, the increasing prevalence of resistance to biocides is a risk to public health. Bacterial exposure to the biocide, benzalkonium chloride (BAC), resulted in a unique transcriptomic profile, characterised by both a short and long-term response. Differential gene expression was observed in four main areas: motility, membrane composition, proteostasis, and the stress response. A metabolism shift to protect the proteome and the stress response were prioritised suggesting these are main resistance mechanisms. Whereas "well-established" mechanisms, such as biofilm formation, were not found to be differentially expressed after exposure to BAC.

A High-Performance and Cost-Effective Field Programmable Gate Array-Based Motor Drive Emulator.

This work presents a hardware-based digital emulator capable of digitally driving a permanent magnet synchronous machine electronic setup. The aim of this work is to present a high-performance, cost-effective, and portable complementary solution when new paradigms of electronic drive design are generated, such as machine early failure detection, fault-tolerant drive, and high-performance control strategy implementations. In order to achieve the high performance required by the digital emulator, the electronic drive models (permanent-magnet synchronous machine, voltage-source inverter, motor-control strategy) are digitally described in Verilog hardware description language and implemented on a field programmable gate array (FPGA) digital platform using two approaches: parallel and sequential methods. The results obtained show the effectiveness of the digital emulator design, and the resources used by the solution presented can be implemented on a low-cost digital platform that reveals a cost-effective operation of the solution presented.

Discrimination of Hover Fly Species and Sexes by Wing Interference Signals.

Remote automated surveillance of insect abundance and diversity is poised to revolutionize insect decline studies. The study reveals spectral analysis of thin-film wing interference signals (WISs) can discriminate free-flying insects beyond what can be accomplished by machine vision. Detectable by photonic sensors, WISs are robust indicators enabling species and sex identification. The first quantitative survey of insect wing thickness and modulation through shortwave-infrared hyperspectral imaging of 600 wings from 30 hover fly species is presented. Fringy spectral reflectance of WIS can be explained by four optical parameters, including membrane thickness. Using a Naïve Bayes Classifier with five parameters that can be retrieved remotely, 91% is achieved accuracy in identification of species and sexes. WIS-based surveillance is therefore a potent tool for remote insect identification and surveillance.

The Na+,K+-ATPase and its stoichiometric ratio: some thermodynamic speculations.

 Almost seventy years after its discovery, the sodium-potassium adenosine triphosphatase (the sodium pump) located in the cell plasma membrane remains a source of novel mechanistic and physiologic findings. A noteworthy feature of this enzyme/transporter is its robust stoichiometric ratio under physiological conditions: it sequentially counter-transports three sodium ions and two potassium ions against their electrochemical potential gradients per each hydrolyzed ATP molecule. Here we summarize some present knowledge about the sodium pump and its physiological roles, and speculate whether energetic constraints may have played a role in the evolutionary selection of its characteristic stoichiometric ratio.

p16INK4a and pRb expression in laryngeal squamous cell carcinoma with and without infection by EBV or different genotypes of HPV: a retrospective study.

BACKGROUND: Laryngeal squamous cell carcinoma (LSCC) represents one of the principal tumors of the head and neck. Human papillomavirus (HPV) and Epstein-Barr virus (EBV) are considered risk factors for the development and the clinical prognosis of LSCC. High levels of p16INK4a are suggested as a surrogate marker of HPV or EBV infection in some head and neck tumors but in LSCC is still controversial. Furthermore, pRb expression may be considered an additional biomarker but it has not been clearly defined. This work aimed to compare the expression of pRb and p16INK4a as possible biomarkers in tumor tissues with and without infection by EBV or different genotypes of HPV from patients with LSCC. METHODS: Tumor samples from 103 patients with LSCC were previously investigated for the presence and genotypes of HPV using the INNO-LiPA line probe assay and for the infection of EBV by qPCR. p16 INK4a and pRb expression was assessed by immunohistochemistry. RESULTS: Of the 103 tumor samples, expression of p16INK4a was positive in 55 (53.4%) and of this, 32 (56.1%) were positive for HPV whereas 11 (39.3%) were EBV positive but both without a significantly difference (p > 0.05). pRb expression was positive in 78 (75.7%) and a higher frequency of this expression was observed in HPV negative samples (87.0%) (p = 0.021) and in high-risk HPV negative samples (85.2%) (p = 0.010). No difference was observed when comparing pRb expression and EBV infection status (p > 0.05). CONCLUSION: Our results support the suggestion that p16INK4a is not a reliable surrogate marker for identifying HPV or EBV infection in LSCC. On the other hand, most of our samples had pRb expression, which was more frequent in tumors without HPV, suggesting that pRb could indicate HPV negativity. However, more studies with a larger number of cases are required, including controls without LSCC and evaluating other molecular markers to determine the real role of p16INK4a and pRb in LSCC.

Life Table Parameters of Tetranychus merganser Boudreaux (Acari: Tetranychidae) on Five Host Plants.

The quality of the host plant affects the life history parameters of tetranychid mites. The biology and fertility life tables of Tetranychus merganser on five host plants (Carica papaya, Phaseolus vulgaris, Capsicum annuum var. glabriusculum, Helietta parvifolia, and Rosa hybrida) were assessed under laboratory conditions at 28 ± 1 °C and 70-80% relative humidity (RH) with a photoperiod of 12:12 h (L:D). The development period of immature females differed among the tested host plants and ranged from 9.32 days on P. vulgaris to 11.34 days on H. parvifolia. For immature males, it ranged from 9.25 days on P. vulgaris to 11.50 days on H. parvifolia. The female survival rate varied from 53.97% on H. parvifolia to 94.74% on P. vulgaris. The highest total fecundity rate was recorded on P. vulgaris (125.40 eggs/female) and the lowest on H. parvifolia (43.92 eggs/female). The intrinsic rate of increase (rm) varied from 0.271 (H. parvifolia) to 0.391 (P. vulgaris). The net reproductive rate (RO) was higher on P. vulgaris than on the other host plants. The longest mean generation time (GT) was calculated on C. annuum var. glabriusculum and the shortest on Rosa hybrida. The demographic parameters suggest the unsuitability of H. parvifolia as the host for the development of red spider mites, and the best performance of T. merganser was on P. vulgaris.

Reporte de Pecari tajacu y Procyon lotor con anomalías cromáticas en el Estado de Guerrero, México

Este trabajo documenta el primer registro de anomalías cromáticas en el pecarí de collar (Pecari tajacu) y el tercero en el mapache (Procyon lotor) para México. Los hallazgos se realizaron durante el monitoreo realizado entre el 2009 y el 2021, utilizando cámaras-trampa, principalmente en la ecorregión de la Sierra Madre del Sur del estado de Guerrero, México. Procyon lotor fue registrado entre el 5 de noviembre y el 1 de diciembre de 2019, en vegetación riparia de bosque tropical caducifolio (17°47'35"N, 98°39'59"W, 1134 m de altitud). Mientras que Pecari tajacu se registró el 7 de junio y el 22 de julio del 2021 en una brecha saca cosecha abandonada (17°38'12"N, 100°40'50"W; 1532 m de altitud).

This paper documents the first record of chromatic anomalies in Collared Peccary (Pecari tajacu) and the third in the Raccoon (Procyon lotor) for Mexico. The findings were made during monitoring conducted between 2009 and 2021, using camera traps, primarily in the Sierra Madre del Sur ecoregion of the state of Guerrero, Mexico. Procyon lotor was recorded between November 5th and December 1st, 2019, in riparian vegetation of a deciduous tropical forest (17°47'35"N, 98°39'59"W, 1134 m altitude). Meanwhile, Pecari tajacu was recorded on June 7th and July 22nd, 2021, in an abandoned crop clearing (17°38'12"N, 100°40'50"W; 1532 m altitude).

The Hormetic Effect Observed for Benzalkonium Chloride and Didecyldimethylammonium Chloride in Serratia sp. HRI.

Hormesis, or the hormetic effect, is a dose- or concentration-dependent response characterised by growth stimulation at low concentrations and inhibition at high concentrations. The impact of sub-lethal levels of disinfectants on the growth of Serratia species is critical to understanding the increasing number of outbreaks caused by this pathogen in healthcare settings. Serratia sp. HRI and Serratia marcescens ATCC 13880 were cultivated in sub-lethal levels of benzalkonium chloride (BAC), Didecyldimethylammonium chloride (DDAC), and VirukillTM. The maximum specific growth rates, doubling times, and cell counts were compared. The results revealed significant increases in maximum specific growth rates and shorter doubling times for Serratia sp. HRI when cultivated in sub-lethal levels of BAC and DDAC. The significant stimulatory effect of sub-lethal levels of these disinfectants for Serratia sp. HRI represents the first time hormesis has been observed in a Gram-negative bacterium for any disinfectant. Furthermore, this study is the first to observe the hormetic effect after treatment with DDAC and the second study to date analysing the impact of sub-lethal levels of disinfectants on the growth of bacterial species.

Remote Nanoscopy with Infrared Elastic Hyperspectral Lidar.

Monitoring insects of different species to understand the factors affecting their diversity and decline is a major challenge. Laser remote sensing and spectroscopy offer promising novel solutions to this. Coherent scattering from thin wing membranes also known as wing interference patterns (WIPs) have recently been demonstrated to be species specific. The colors of WIPs arise due to unique fringy spectra, which can be retrieved over long distances. To demonstrate this, a new concept of infrared (950-1650 nm) hyperspectral lidar with 64 spectral bands based on a supercontinuum light source using ray-tracing and 3D printing is developed. A lidar with an unprecedented number of spectral channels, high signal-to-noise ratio, and spatio-temporal resolution enabling detection of free-flying insects and their wingbeats. As proof of principle, coherent scatter from a damselfly wing at 87 m distance without averaging (4 ms recording) is retrieved. The fringed signal properties are used to determine an effective wing membrane thickness of 1412 nm with ±4 nm precision matching laboratory recordings of the same wing. Similar signals from free flying insects (2 ms recording) are later recorded. The accuracy and the method's potential are discussed to discriminate species by capturing coherent features from free-flying insects.

Intelligent Fuzzy System to Predict the Wisconsin Breast Cancer Dataset.

Decision Support Systems (DSSs) are solutions that serve decision-makers in their decision-making process. For the development of these intelligent systems, two primary components are needed: the knowledge database and the knowledge rule base. The objective of this research work was to implement and validate diverse clinical decision support systems supported by Mamdani-type fuzzy set theory using clustering and dynamic tables. The outcomes were evaluated with other works obtained from the literature to validate the suggested fuzzy systems for categorizing the Wisconsin breast cancer dataset. The fuzzy Inference Systems worked with different input features, according to the studies obtained from the literature. The outcomes confirm that most performance' metrics in several cases were greater than the achieved results from the literature for the output variable for the different Fuzzy Inference Systems-FIS, demonstrating superior precision.

Improving capacity for phytoremediation of Vetiver grass and Indian mustard in heavy metal (Al and Mn) contaminated water through the application of clay minerals.

One of the consequences of mining is the release of heavy metals into the environment, especially water bodies. Phytoremediation of areas contaminated by heavy metals using Vetiver grass and Indian mustard is cost-effective and environmentally friendly. This study aimed at enhancing remediation of heavy metal contaminated water through the simultaneous hybrid application of clay minerals (attapulgite and bentonite) and Vetiver grass or Indian mustard. A 21-day greenhouse experiment was carried out to investigate the effectiveness of the clay minerals to improve heavy metal phytoremediation. The highest accumulation of aluminium (Al) by Vetiver grass was 371.8 mg/kg in the BT2.5VT treatment, while for Mn, the highest accumulation of 34.71 mg/kg was observed in the AT1VT treatment. However, Indian mustard showed no significant uptake of heavy metals, but suffered heavy metal toxicity despite the addition of clay minerals. From this study, it was evident that bentonite added at 2.5% (w/v) could improve the phytoremediation capacity of Vetiver grass for Al and Mn polluted water. The current laboratory-scale findings provided a basis for field trials earmarked for remediation in a post-mining coal environment in South Africa. This remediation approach can also be adopted in other places.

Cryopreservation of the Microalgae Scenedesmus sp.

Each phytoplankton species presents a different behavior and tolerance to the cryopreservation process. Therefore, in a species-specific protocol, it is essential to ensure both growth and post-thawing cell viability. In this study, we explored the effect of cryopreservation of Scenedesmus sp. with two cryoprotectants, dimethyl sulfoxide (DMSO) and methanol (MET), at 5% and 10% inclusion for each. In the control treatment, the microalgae were not exposed to cryoprotective agents (Control). Three post-thawing cell viability criteria were used: no cell damage (NCD), cell damage (CD), and marked lesions (LM), and mitochondrial and cell membrane damage was evaluated by flow cytometry. The study was a 2 × 2 factorial design, with five replications by treatments, population growth, and cell damage evaluated from the fifth day after thawing. On the fifth day, the highest percentage of NCD was observed when the microalgae were cryopreserved with DMSO 5% (50%); Regarding the control group, it showed 0% NCD. Flow cytometry analysis reveals minor damage at the membrane and mitochondria (9-10.7%) when DMSO is used at both inclusion percentages (5-10%) after thawing. In the exponential phase, the highest growth rates, doubling time, and yield was observed in cryopreserved cells with MET 5%. The results suggest that DMSO 5% is an ideal treatment for cryopreserving microalgae Scenedesmus sp.

Use of Outpatient Health Services by Mexicans Aged 15 Years and Older, According to Ethnicity.

The aim of this study was to estimate the prevalence of health needs and use of outpatient services for indigenous (IP) and non-indigenous (NIP) populations aged ≥15 years, and to explore the associated factors and types of need. A cross-sectional study was conducted based on the 2018-19 National Health and Nutrition Survey. The population aged ≥15 years who had health needs and used outpatient services was identified. Logistic models were developed to explore the factors underlying the use of outpatient services. For both populations, being a woman increased the likelihood of using health services, and having health insurance was the most important variable in explaining the use of public health services. Compared to the NIP, a lower proportion of IP reported health needs during the month prior to the survey (12.8% vs. 14.7%); a higher proportion refrained from using outpatient services (19.6% vs. 12.6%); and a slightly higher proportion used public health services (56% vs. 55.4%). For the NIP, older age and belonging to a household that had received cash transfers from a social program, had few members, a high socioeconomic level, and a head with no educational lag, all increased the likelihood of using public health services. It is crucial to implement strategies that both increase the use of public health services by the IP and incorporate health-insurance coverage as a universal right.

Roles of early events in the modifications undergone by bovine corneal endothelial cells during wound healing.

A mechanical injury in bovine corneal endothelial (BCE) cells in culture induces: (1) a fast calcium wave (FCW); (2) slow increases in cytosolic sodium and calcium, critical for the healing process, and (3) a rise in the apoptotic rate with respect to quiescent cells. In order to investigate the nature of the stimuli that determine the ionic changes and apoptotic response, we performed here studies on a non-injury model of tissue restitution in BCE monolayers. For this, we employed cell cultures grown to confluence in the presence of a Parafilm strip. We observed that, previously to strip removal, most of the border cells had already developed the slow ionic modifications, while in the scratch wounds these changes gradually occur after several hours of healing. This finding suggests that, in BCE cells, the presence of a free edge is sufficient to trigger ionic modifications necessary for wound healing and to elicit an augmented apoptotic response. The apoptotic index of the migrating cells in the Parafilm model (PF) was determined to be approximately two-fold the one of scratch wounds, a result that, in agreement with our previous observations, we attributed to the absence of the FCW in the PF experiments. The findings of this work further contribute to the understanding of epithelial wound healing, a crucial adaptive, and homeostatic response.

A mathematical model of wound healing in bovine corneal endothelium.

We developed a mathematical model to describe healing processes in bovine corneal endothelial (BCE) cells in culture, triggered by mechanical wounds with parallel edges. Previous findings from our laboratory show that, in these cases, BCE monolayers exhibit an approximately constant healing velocity. Also, that caspase-dependent apoptosis occurs, with the fraction of apoptotic cells increasing with the distance traveled by the healing edge. In addition, in this study we report the novel findings that, for wound scratch assays performed preserving the basal extracellular matrix: i) the healing cells increase their en face surface area in a characteristic fashion, and ii) the average length of the segments of the cell columns actively participating in the healing process increases linearly with time. These latter observations preclude the utilization of standard traveling wave formalisms to model wound healing in BCE cells. Instead, we developed and studied a simple phenomenological model based on a plausible formula for the spreading dynamics of the individual healing cells, that incorporates original evidence about the process in BCE cells. The model can be simulated to: i) obtain an approximately constant healing velocity; ii) reproduce the profile of the healing cell areas, and iii) obtain approximately linear time dependences of the mean cell area and average length of the front active segments per column. In view of its accuracy to account for the experimental observations, the model can also be acceptably employed to quantify the appearance of apoptotic cells during BCE wound healing. The strategy utilized here could offer a novel formal framework to represent modifications undergone by some epithelial cell lines during wound healing.

Response rate in cardiac resynchronization therapy patients implanted with a left ventricular quadripolar lead and the MultiPoint™ pacing feature early activated. QUARTO III.

BACKGROUND: Although cardiac resynchronization therapy (CRT) is beneficial in most heart failure patients, up to 40% do not respond to CRT. It has been suggested that multipoint left ventricle pacing (MPP) would increase the response rate. AIM: To assess the CRT response rate at 6 months in patients implanted with a CRT device with the MPP feature activated early after the implant. METHODS: This was a multicentre, prospective, open-label and non-randomized study. The primary endpoint was response to biventricular pacing defined as >15% relative reduction in left ventricular end-systolic volume (LVESV) comparing echocardiography measurements performed at baseline and 6 months by a core laboratory. Among secondary endpoints the combined endpoint of mortality or all-cause hospitalizations was evaluated. Primary study endpoint and clinical outcomes were compared to a Quarto II control cohort. RESULTS: Totally, 105 patients were included. The response rate was 64.6% (97.5% lower confidence bound 53%). Mean relative reduction in LVESV was 25.3%, and mean absolute increase in LVEF was 9.4%. The subjects with device programmed using anatomical approach showed a trend towards higher responder rate than those using the electrical approach (72% vs. 61.1%, p = 0.32). Finally, the combined incidence of mortality and or all-cause hospitalizations at 6 month was 12.4%. CONCLUSIONS: Early activation of MPP was not associated to an advantage increasing echocardiography responders to CRT at 6 months of follow-up. Nevertheless, patients programmed using widest pacing cathodes had a numerically higher responder rate. Finally, early activation of MPP was associated to a low incidence of clinical endpoints at 6 months of follow-up.

The Characterization of Cardiac Explants Reveals Unique Fibrosis Patterns and a Predominance of CD8+ T Cell Subpopulations in Patients with Chronic Chagas Cardiomyopathy.

AIM: The present study aimed to characterize the histopathological findings and the phenotype of inflammatory cells in the myocardial tissue of patients with end-stage heart failure (ESHF) secondary to CCC in comparison with ESHF secondary to non-Chagas cardiomyopathies (NCC). METHODS: A total of 32 explanted hearts were collected from transplanted patients between 2014 and 2017. Of these, 21 were classified as CCC and 11 as other NCC. A macroscopic analysis followed by a microscopic analysis were performed. Finally, the phenotypes of the inflammatory infiltrates were characterized using flow cytometry. RESULTS: Microscopic analysis revealed more extensive fibrotic involvement in patients with CCC, with more frequent foci of fibrosis, collagen deposits, and degeneration of myocardial fibers, in addition to identifying foci of inflammatory infiltrate of greater magnitude. Finally, cell phenotyping identified more memory T cells, mainly CD8+CD45RO+ T cells, and fewer transitioning T cells (CD45RA+/CD45RO+) in patients with CCC compared with the NCC group. CONCLUSIONS: CCC represents a unique form of myocardial involvement characterized by abundant inflammatory infiltrates, severe interstitial fibrosis, extensive collagen deposits, and marked cardiomyocyte degeneration. The structural myocardial changes observed in late-stage Chagas cardiomyopathy appear to be closely related to the presence of cardiac fibrosis and the colocalization of collagen fibers and inflammatory cells, a finding that serves as a basis for the generation of new hypotheses aimed at better understanding the role of inflammation and fibrogenesis in the progression of CCC. Finally, the predominance of memory T cells in CCC compared with NCC hearts highlights the critical role of the parasite-specific lymphocytic response in the course of the infection.