Assessing community-level impacts of and responses to stay at home orders: The King County COVID-19 community study.

BACKGROUND: At the beginning of the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) of unprecedented scope and duration were implemented to limit community spread of COVID-19. There remains limited evidence about how these measures impacted the lived experience of affected communities. This study captured the early impacts and coping strategies implemented in King County, Washington, one of the first U.S. communities impacted by COVID-19. METHODS: We conducted a cross-sectional web-based survey of 793 English- and Spanish-speaking adult King County residents from March 18, 2020 -May 30, 2020, using voluntary response sampling. The survey included close- and open-ended questions on participant demographics, wellbeing, protective actions, and COVID-19-related concerns, including a freeform narrative response to describe the pandemic's individual-, family- and community-level impacts and associated coping strategies. Descriptive statistics were used to analyze close-ended questions, and qualitative content analysis methods were used to analyze free-form narrative responses. RESULTS: The median age of participants was 45 years old, and 74% were female, 82% were White, and 6% were Hispanic/Latinx; 474 (60%) provided a qualitative narrative. Quantitative findings demonstrated that higher percentages of participants engaged in most types of COVID-19 protective behaviors after the stay-at-home order was implemented and schools and community spaces were closed, relative to before, and that participants tended to report greater concern about the pandemic's physical health or healthcare access impacts than the financial or social impacts. Qualitative data analysis described employment or financial impacts (56%) and vitality coping strategies (65%), intended to support health or positive functioning. CONCLUSIONS: This study documented early impacts of the COVID-19 pandemic and the NPIs implemented in response, as well as strategies employed to cope with those impacts, which can inform early-stage policy formation and intervention strategies to mitigate the negative impacts. Future research should explore the endurance and evolution of the early impacts and coping strategies throughout the multiyear pandemic.

Should we think about green or white analytical chemistry? Case study: Accelerated sample preparation using an ultrasonic bath for the simultaneous determination of Mn and Fe in beef.

Green Analytical Chemistry (GAC) metrics include a variety of criteria, such as the regent amounts and toxicity, energy consumption, generated waste, among others. The analytical greenness metric (AGREE) and its variant for sample preparation (AGREEprep) cover different aspects that contribute to the environmental sustainability of sample preparation. White Analytical Chemistry (WAC) considers not only environmental aspects but also analytical and practical aspects with a holistic vision based on a Red-Green-Blue color model. A case study is presented to assess the green and white profile of a method based on ultrasound-assisted extraction and determination of Mn and Fe in beef using microwave-induced plasma atomic emission spectroscopy (MP AES). The method was validated and resulted simple, fast without external heating using diluted acids. It was concluded that we should think in green sample preparation with the AGREEprep tool, as well as in white holistic assessments (WAC) as both constitute complementary tools.

Exploiting Ambipolarity in Graphene Field-Effect Transistors for Novel Designs on High-Frequency Analog Electronics.

Exploiting ambipolar electrical conductivity based on graphene field-effect transistors has raised enormous interest for high-frequency (HF) analog electronics. Controlling the device polarity, by biasing the graphene transistor around the vertex of the V-shaped transfer curve, enables to redesign and highly simplify conventional analog circuits, and simultaneously to seek for multifunctionalities, especially in the HF domain. This study presents new insights for the design of different HF applications such as power amplifiers, mixers, frequency multipliers, phase shifters, and modulators that specifically leverage the inherent ambipolarity of graphene-based transistors.

Community Health Workers in Early Childhood Well-Child Care for Medicaid-Insured Children: A Randomized Clinical Trial.

Importance: An intervention model (the Parent-focused Redesign for Encounters, Newborns to Toddlers; the PARENT intervention) for well-child care that integrates a community health worker into preventive care services may enhance early childhood well-child care. Objective: To examine the effectiveness of the PARENT intervention vs usual care for parents with children younger than 2 years of age. Design, Setting, and Participants: A cluster randomized clinical trial was conducted between March 2019 and July 2022. Of the 1283 parents with a child younger than 2 years of age presenting for a well-child visit at 1 of the 10 clinic sites (2 federally qualified health centers in California and Washington) approached for trial participation, 937 were enrolled. Intervention: Five clinics implemented the PARENT intervention, which is a team-based approach to care that uses a community health worker in the role of a coach (ie, health educator) as part of the well-child care team to provide comprehensive preventive services, and 5 clinics provided usual care. Main Outcomes and Measures: There were 2 primary outcomes: score for parent-reported receipt of recommended anticipatory guidance during well-child visits (score range, 0-100) and emergency department (ED) use (proportion with ≥2 ED visits). The secondary outcomes included psychosocial screening, developmental screening, health care use, and parent-reported experiences of care. Results: Of the 937 parents who were enrolled, 914 remained eligible to participate (n = 438 in the intervention group and n = 476 in the usual care group; 95% were mothers, 73% reported Latino ethnicity, and 63% reported an annual income <$30 000). The majority (855/914; 94%) of the children (mean age, 4.4 months at parental enrollment) were insured by Medicaid. Of the 914 parents who remained eligible and enrolled, 785 (86%) completed the 12-month follow-up interview. Parents of children treated at the intervention clinics (n = 375) reported receiving more anticipatory guidance than the parents of children treated at the usual care clinics (n = 407) (mean score, 73.9 [SD, 23.4] vs 63.3 [SD, 27.8], respectively; adjusted absolute difference, 11.01 [95% CI, 6.44 to 15.59]). There was no difference in ED use (proportion with ≥2 ED visits) between the intervention group (n = 376) and the usual care group (n = 407) (37.2% vs 36.1%, respectively; adjusted absolute difference, 1.2% [95% CI, -5.5% to 8.0%]). The effects of the intervention on the secondary outcomes included a higher amount of psychosocial assessments performed, a greater number of parents who had developmental or behavioral concerns elicited and addressed, increased attendance at well-child visits, and greater parental experiences with the care received (helpfulness of care). Conclusions and Relevance: The intervention resulted in improvements in the receipt of preventive care services vs usual care for children insured by Medicaid by incorporating community health workers in a team-based approach to early childhood well-child care. Trial Registration: ClinicalTrials.gov Identifier: NCT03797898.

Effect of Adding Bovine Skin Gelatin Hydrolysates on Antioxidant Properties, Texture, and Color in Chicken Meat Processing.

(1) Background: Phosphates are used in the food industry to improve water retention and product quality. However, when consumed in excess, they can be harmful to health. Instead, bovine skin gelatin hydrolysates present health benefits such as being a rejuvenating agent, stimulating collagen production, and improving food quality, in addition to being a source of protein. The effect of the addition of bovine skin gelatin hydrolysates on the texture and color of thermally processed chicken meat (boiled type) and antioxidant activity was evaluated. (2) Methods: Hydrolysates were prepared with subtilisin with the degree of hydrolysis being 6.57 and 13.14%, which were obtained from our previous study. (3) Results: The hydrolysates improved the firmness of the meat matrix compared to the control. Additionally, the hydrolysate with a 13.14% degree of hydrolysis reached the same firmness (p > 0.05) as the commercial ingredient sodium tripolyphosphate at its maximum limit allowed in the food industry when it was applied at 5% (w/w meat) in the meat matrix, improving firmness over the control by 63%. Furthermore, both hydrolysates reached a similar color difference to sodium tripolyphosphate at its maximum allowed limit when applied at a concentration of 2% (w/w meat). Additionally, it was found that these hydrolysates obtained the same antioxidant activity as sodium tripolyphosphate, capturing free radicals at 10%. (4) Conclusion: The findings of this study suggest that bovine skin gelatin hydrolysates can be applied as an ingredient with functional properties, being an alternative to phosphates to improve the quality of meat products.

Toward a realistic in silico abdominal phantom for QSM.

PURPOSE: QSM outside the brain has recently gained interest, particularly in the abdominal region. However, the absence of reliable ground truths makes difficult to assess reconstruction algorithms, whose quality is already compromised by additional signal contributions from fat, gases, and different kinds of motion. This work presents a realistic in silico phantom for the development, evaluation and comparison of abdominal QSM reconstruction algorithms. METHODS: Synthetic susceptibility and R 2 * $$ {R}_2^{\ast } $$ maps were generated by segmenting and postprocessing the abdominal 3T MRI data from a healthy volunteer. Susceptibility and R 2 * $$ {R}_2^{\ast } $$ values in different tissues/organs were assigned according to literature and experimental values and were also provided with realistic textures. The signal was simulated using as input the synthetic QSM and R 2 * $$ {R}_2^{\ast } $$ maps and fat contributions. Three susceptibility scenarios and two acquisition protocols were simulated to compare different reconstruction algorithms. RESULTS: QSM reconstructions show that the phantom allows to identify the main strengths and limitations of the acquisition approaches and reconstruction algorithms, such as in-phase acquisitions, water-fat separation methods, and QSM dipole inversion algorithms. CONCLUSION: The phantom showed its potential as a ground truth to evaluate and compare reconstruction pipelines and algorithms. The publicly available source code, designed in a modular framework, allows users to easily modify the susceptibility, R 2 * $$ {R}_2^{\ast } $$ and TEs, and thus creates different abdominal scenarios.

Caracterización demográfica y clínica de pacientes críticos con neumonía por influenza A H1N1 / Demographic and clinical characterization of critically ill patients with influenza A H1N1 pneumonia

INTRODUCCIÓN. La epidemia de influenza y sus complicaciones profundizaron el estudio de las neumonías virales en cuidados intensivos. En nuestro país hay pocos datos sobre este tema. OBJETIVOS. Realizar una caracterización demográfica y clínica de pacientes críticos con neumonía por Influenza A H1N1 en un hospital de tercer nivel de complejidad. MATERIALES Y MÉTODOS. Estudio observacional, analítico, retrospectivo, con análisis univariante y multivariante. Población de 293 y muestra de 44 datos de historias clínicas electrónicas de pacientes diagnosticados con A H1N1 ingresados a la Unidad de cuidados intensivos del Hospital de Especialidades Carlos Andrade Marín en el período enero 2016 a diciembre de 2018. Como criterios de inclusión se consideró a todos los pacientes adultos mayores de 18 años que ingresaron a la UCI, con el diagnóstico de neumonía comunitaria grave con confirmación por reacción de cadena de polimerasa en tiempo real para influenza A H1N1 en hisopado nasal o aspirado traqueal. Se excluyó a pacientes embarazadas con diagnóstico de influenza A H1N1, pacientes con más de 48 horas de ingreso hospitalario previo a su ingreso a UCI, pacientes con datos insuficientes en los registros. Los datos se obtuvieron del sistema AS-400. El análisis estadístico se realizó en el programa Statistical Package for Social Sciences, versión 22. El nivel de significación fue una p<0.05. RESULTADOS. La prevalencia en pacientes críticos de neumonía por influenza A H1N1 durante 2016-2018 fue de 16,72%, la mediana de edad fue de 55 años, 25% masculinos, 34% obesos, 34% con hipertensión arterial. Escala "Acute Physiology and Chronic Health Evaluation II" 23,50, "Simplified Acute Physiologic Score III" 54, "Sepsis related Organ Failure Assessment" 11,50, Lactato deshidrogenasa 99,50, Procalcitonina 0,99; 9 días de ventilación mecánica invasiva, 10,50 días de estancia en la unidad. El 91% presentó shock séptico, 59% lesión renal aguda. El 89% tuvo Síndrome de Distrés Respiratorio del Adultos, 69% fue grave, 87% usó ventilación mecánica, 38,50% corticoides, 36% posición prona, Presión parcial de oxígeno/Fracción inspirada de oxígeno 74, volumen tidal/kilogramo de 7 mililitros, presión plateau de 27,50 centímetros de agua. La mortalidad general en la Unidad de Cuidados Intensivos fue de 38,63% y a los 28 días de 63,60%, en shock séptico fue 42,50% y en Síndrome de Distrés Respiratorio del Adultos del 41,02%. El análisis de regresión logística multivariable identificó como factores independientes asociados a mortalidad el incremento de Lactato deshidrogenasa (OR 2,69, 9% IC 1,090-6,642) y Procalcitonina (OR 2,51, IC 1,005-6,272). CONCLUSIONES. Las características, frecuencia y mortalidad de este grupo de pacientes críticos con neumonía por influenza A H1N1 son similares a lo reportado en la literatura mundial.

INTRODUCTION. The influenza epidemic and its complications deepened the study of viral pneumonias in intensive care. In our country there is little data on this subject. OBJECTIVES. To perform a demographic and clinical characterization of critical patients with pneumonia due to pneumonia due to Influenza A H1N1 in a third level hospital. MATERIALS AND METHODS. Observational, analytical, retrospective study, with univariate and multivariate analysis. We compared the groups of dead patients and survivors. The significance level was p<0,05. RESULTS. The prevalence in critically ill patients of influenza A H1N1 pneumonia during 2016-2018 was 16,72%, 44 cases were collected, median age 55 years, 25% male, 34% obese, 34% with arterial hypertension. APACHE II 23,50, SAPS III 54, SOFA 11,50, LDH 99,50, PCT 0,99, 9 days of invasive mechanical ventilation, 10,50 days of unit stay. 91% presented septic shock, 59% with acute kidney injury 89% had ARDS, 69% were severe, 87% used mechanical ventilation, 38,50% corticosteroids, 36% prone position, PaO2/FiO2 74, tidal volume/kg of 7 ml, plateau pressure of 27,50 cmH2O. Overall mortality in the ICU was 38,63% and at 28 days was 63,60%, in septic shock it was 42,50% and in Adult Respiratory Distress Syndrome it was 42,50%. was 42,50% and 41,02% in Adult Respiratory Distress Syndrome. The ultivariate logistic regression analysis identified as independent factors associated with mortality, the increase in LDH (OR 2,69, 9% CI 1,090-6,642) and PCT (OR 2,51, CI 1,005-6,272). CONCLUSIONS. The characteristics, frequency and mortality of this group of critical patients with pneumonia due to influenza A H1N1 are similar to those reported in the world literature.

High-altitude is associated with better short-term survival in critically ill COVID-19 patients admitted to the ICU.

BACKGROUND: Multiple studies have attempted to elucidate the relationship between chronic hypoxia and SARS-CoV-2 infection. It seems that high-altitude is associated with lower COVID-19 related mortality and incidence rates; nevertheless, all the data came from observational studies, being this the first one looking into prospectively collected clinical data from severely ill patients residing at two significantly different altitudes. METHODS: A prospective cohort, a two-center study among COVID-19 confirmed adult patients admitted to a low (sea level) and high-altitude (2,850 m) ICU unit in Ecuador was conducted. Two hundred and thirty confirmed patients were enrolled from March 15th to July 15th, 2020. RESULTS: From 230 patients, 149 were men (64.8%) and 81 women (35.2%). The median age of all the patients was 60 years, and at least 105 (45.7%) of patients had at least one underlying comorbidity, including hypertension (33.5%), diabetes (16.5%), and chronic kidney failure (5.7%). The APACHE II scale (Score that estimates ICU mortality) at 72 hours was especially higher in the low altitude group with a median of 18 points (IQR: 9.5-24.0), compared to 9 points (IQR: 5.0-22.0) obtained in the high-altitude group. There is evidence of a difference in survival in favor of the high-altitude group (p = 0.006), the median survival being 39 days, compared to 21 days in the low altitude group. CONCLUSION: There has been a substantial improvement in survival amongst people admitted to the high-altitude ICU. Residing at high-altitudes was associated with improved survival, especially among patients with no comorbidities. COVID-19 patients admitted to the high-altitude ICU unit have improved severity-of-disease classification system scores at 72 hours.

Finite element analysis of thoracic vertebral stability supported by the fourth spine / Análise de elementos finitos da estabilidade vertebral torácica suportada pela quarta coluna / Análisis de elementos finitos de la estabilidad vertebral torácica aportada por la cuarta columna

ABSTRACT Objective: In traumatic injuries of the thoracic spine, three variables are analyzed to make decisions: morphology of the injury, posterior ligamentous complex and neurological status; currently the fourth column is not evaluated; our objective was to determine the biomechanical behavior of the spine with a fracture of the fifth thoracic vertebral body when accompanied by a short oblique fracture of the sternum. Methods: An anonymous model of a healthy 25-year-old male was used, from which the thoracic spine and rib cage were obtained; in addition to the ligaments of the posterior complex and the intervertebral discs, four models were simulated. An axial section was made, a load of 400 N was applied, and the biomechanical behavior of each model was determined. Results: The area that suffered the most stress at the vertebral level was the posterior column of T4-T5 (tensile strength of 747 MPa), which exceeded the plastic limit, the load through the ribs was distributed from the first to the sixth (100 MPa), in the sternum the stress increased (200 MPa), the deformity increased to 45 mm. Conclusions: The sternum was a fundamental part of the spine's stability; the combined injury severely increased the stress (8 MPa to 747 MPa) in the spine and exceeded the plastic limit, which generated an instability that is represented by the global deformity acquired (1 mm to 45 mm). Level of evidence II; Prospective comparative study.

RESUMO Objetivo: Nas lesões traumáticas da coluna torácica, três variáveis são analisadas para tomada de decisão: morfologia da lesão, complexo ligamentar posterior e estado neurológico; atualmente a quarta coluna não é avaliada, nosso objetivo foi determinar o comportamento biomecânico da coluna com fratura do quinto corpo vertebral torácico quando acompanhada de fratura oblíqua curta do esterno. Métodos: Obteve-se um modelo anônimo de um homem saudável de 25 anos, do qual foram obtidas a coluna torácica e caixa torácica, além dos ligamentos do complexo posterior e dos discos intervertebrais, foram simulados 4 modelos, foi feito o corte, e foi aplicada uma carga de 400 N e o comportamento biomecânico de cada modelo foi estendido. Resultados: A área que mais sofreu estresse ao nível vertebral foi a coluna posterior de T4-T5 (resistência à tração de 747 MPa), que ultrapassou o limite plástico, a carga pelas costelas foi distribuída da primeira à sexta (100 MPa), no esterno a maior tensão (200 MPa), a deformidade maior que 45 mm. Conclusões: O esterno foi a peça fundamental na estabilidade da coluna, a lesão combinada aumentou severamente o estresse (8 MPa a 747 MPa) na coluna e ultrapassou o limite plástico, o que mantém uma instabilidade que é representada pela deformidade global adquirida (1 mm a 45 mm). Nível de evidência II; Estudo prospectivo comparativo.

RESUMEN Objetivo: En las lesiones traumáticas de la columna torácica se analizan tres variables para tomar decisiones: morfología de la lesión, complejo ligamentoso posterior y estado neurológico; actualmente no se evalúa la cuarta columna, nuestro objetivo fue determinar el comportamiento biomecánico de la columna con una fractura del quinto cuerpo vertebral torácico cuando se acompaña de una fractura oblicua corta del esternón. Métodos: Se utilizó un modelo anónimo de sexo masculino sano de 25 años de edad, del cual se obtuvo la columna torácica, y la caja torácica, además se le agregaron los ligamentos del complejo posterior y los discos intervertebrales, se simularon 4 modelos a los cuales se les realizó un corte axial, se aplicó una carga de 400 N y se determinó el comportamiento biomecánico de cada modelo. Resultados: La zona que más estrés sufrió a nivel vertebral fue la columna posterior de T4-T5 (resistencia a la tracción de 747 MPa), la cual superó el límite plástico, la carga a través de las costillas se distribuyó de la primera a la sexta (100 MPa), en el esternón el estrés aumentó (200 MPa), la deformidad aumentó a 45 mm. Conclusiones: El esternón fue parte fundamental en la estabilidad de la columna, la lesión combinada incrementó severamente el estrés (8 MPa a 747 MPa) en la columna y este superó el límite plástico, lo que generó una inestabilidad que se representa por la deformidad global adquirida (1 mm a 45 mm). Nivel de evidencia II; Estudio prospectivo comparativo.

On-Line Preconcentration and Simultaneous Determination of Cu and Mn in Water Samples Using a Minicolumn Packed with Sisal Fiber by MIP OES.

An on-line preconcentration system for the simultaneous determination of Copper (Cu) and manganese (Mn) in water samples was developed and coupled to a microwave-induced plasma optical emission spectrometer (MIP OES). The flow injection system was designed with a minicolumn packed with sisal fiber (Agave sisalana). A multivariate experimental design was performed to evaluate the influence of pH, preconcentration time, and eluent concentration. Optimal conditions for sample preparation were pH 5.5, preconcentration time was 90 s, and HCl 0.5 mol L-1 was the eluent. The main figures of merit were detection limits 3.7 and 9.0 µg L-1 for Cu and Mn, respectively. Precision was expressed as a relative standard deviation better than 10%. Accuracy was evaluated via spiked recovery assays with recoveries between 75-125%. The enrichment factor was 30 for both analytes. These results were adequate for water samples analysis for monitoring purposes. The preconcentration system was coupled and synchronized with the MIP OES nebulizer to allow simultaneous determination of Cu and Mn as a novel sample introduction strategy. The sampling rate was 20 samples/h. Sisal fiber resulted an economical biosorbent for trace element preconcentration without extra derivatization steps and with an awfully time of use without replacement complying with the principles of green analytical methods.

Técnica combinada de microabrasión y blanqueamiento dental para tratamiento de pigmentaciones asociadas a fluorosis. Reporte de un caso / Combined technique of microabrasion and teeth whitening for treatment of surface stains associated with fluorosis. Case Report

La fluorosis dental es una condición irreversible originada durante el desarrollo dental que genera pigmentaciones intrínsecas, alteraciones en el esmalte manifestadas a manera de manchas blancas, amarillas o marrones, que perjudican la estética y repercuten en el desenvolvimiento social. El presente reporte de caso clínico describe la combinación de los procedimientos de microabrasión y blanqueamiento dental, como alternativas en la eliminación de pigmentaciones dentales. Después del diagnóstico de la patología, verificación de ausencia de lesiones pulpares y caries, una explicación minuciosa a la paciente y obtención del consentimiento informado, se realizó limpieza de las superficies dentales y, bajo aislamiento absoluto, se procedió a realizar la técnica de microabrasión mediante ácido clorhídrico al 6,6% siguiendo las instrucciones del fabricante. Concluido el procedimiento y, observando que era posible mejorar aún más la estética, se decidió ejecutar el procedimiento de blanqueamiento dental, a base de peróxido de hidrógeno al 40% en el consultorio, seguido por peróxido de carbamida al 10% aplicado en el domicilio. Al finalizar el tratamiento se observó uniformidad en el color dental, conjugados con una evidente mejora en la calidad de vida y relación social de la paciente. La combinación de procedimientos, como el reportado en este caso, constituye una excelente alternativa de tratamiento para eliminar pigmentaciones fluoróticas moderadas

Dental fluorosis is an irreversible condition caused during dental development that generates intrinsic pigmentation, enamel alterations manifested as white, yellow, or brown spots, which impair aesthetics and have an impact on social development. This clinical case report describes the combination of microabrasion and teeth whitening procedures, as alternatives in the elimination of dental pigmentations. After the diagnosis of the pathology, verification of absence of pulpal lesions and caries, a thorough explanation to the patient and obtaining informed consent; dental surfaces were cleaned and, under absolute isolation, the microabrasion technique was performed using 6.6% hydrochloric acid following the manufacturer's instructions. Once the procedure was concluded and observing that it was possible to improve the aesthetics even further, it was decided to perform the teeth whitening procedure, based on 40% hydrogen peroxide, in the dental office, followed by 10% carbamide peroxide applied at home. At the end of the treatment, uniformity in tooth color was observed, combined with an evident improvement in the quality of life and social relationship of the patient. The combination of procedures, such as that reported in this case, constitutes an excellent treatment alternative to eliminate moderate fluorotic pigmentation

Síndrome de Austrian: quien no sabe lo que busca, no entiende lo que encuentra / Austrian Syndrome: he who does not know what he is looking for will not understand what he finds

Resumen El síndrome de Austrian es una tríada que engloba neumonía, meningitis y endocarditis causadas por Staphylococcus pneumoniae. Dado el aumento en el uso de antibióticos, cada vez vemos esta enfermedad de forma menos frecuente en la práctica clínica diaria. No obstante, se debe recordar su existencia ya que el conocimiento de esta entidad puede ser crucial en el pronóstico de estos enfermos. Desconocer algunos síndromes por presentar una frecuencia menor en los tiempos actuales no exime de mantener la buena práctica clínica ya que de ello puede depender el devenir del paciente. Se presenta un caso de síndrome de Austrian en un paciente joven, quien tuvo evolución tórpida los primeros días de ingreso; finalmente, tras la realización de varias pruebas, se solicitó un ecocardiograma que fue la clave para el diagnóstico. Se trata de un caso de interés para reflexionar en que, a pesar de poseer nuevas tecnologías a nuestro alcance en la actualidad, es preciso recordar la importancia de una buena exploración física.

Abstract Austrian syndrome is a triad that includes pneumonia, meningitis, and endocarditis caused by Staphylococcus pneumoniae. Given the increase in the use of antibiotics, it is becoming less common to see this disease in daily clinical practice. However, it should be remembered that it exists since knowledge of this condition could be crucial in the prognosis of these patients. To not recognise some syndromes due to currently having a lower frequency does not exempt maintaining good clinical practice, since the outcome of the patient may depend on this. A case of Austrian syndrome is presented in a young patient, who had a slow response in the first days of admission. Finally, after performing several tests, a cardiac ultrasound was requested, which was key for the diagnosis. It is an interesting case to reflect that, despite currently having new technologies within our reach, it is essential to remember the importance of a good physical examination.

The acid-base and redox properties of menaquinone MK-4, MK-7, and MK-9 (vitamin K2) in DMPC monolayers on mercury.

The acid-base and redox properties of the menaquinones MK-4, MK-7, and MK-9 (vitamin K2) have been studied in DMPC monolayers on mercury electrodes. The monolayers were prepared by adhesion-spreading of menaquinone-spiked DMPC liposomes on a stationary mercury drop electrode. All three menaquinones possess [Formula: see text] constants outside the experimentally accessible range, i.e., they are higher than about 12. The standard potentials of MK-4, MK-7, and MK-9 in the DMPC monolayers are very similar, i.e., 0.351, 0.326, and 0.330 V (corresponding to the biochemical standard potentials - 0.063, - 0.088, and - 0.085 V).

Exploitation of reaction mechanisms for sensitivity enhancement in the determination of phosphorus by sequential injection analysis.

The molybdenum blue method using antimony and ascorbic acid was studied for the determination of phosphorus (as orthophosphate) by means of sequential injection analysis (SIA). In order to avoid the interference of the Schlieren effect in the photometric measurements a stopped-flow kinetic approach was adopted monitoring the absorbance of the reaction bolus inside the flow cell. Aiming at enhancing the sensitivity of the method, the effect of the order of addition of the reactants was studied. It was found that the best sensitivity was attained by adding separate reagents and acidifying only after the phosphate, molybdate and antimony solutions were already mixed; the reductant (ascorbic acid) was then added. In this way a sensitivity enhancement in excess of 10 times was obtained when compared to the addition of the phosphate solution to the acidified mixture of molybdate and antimony. It is proposed that the difference in sensitivities could be explained by the existence of different mechanisms for the formation of the intermediate phosphoantimonyl molybdic acid (PMA). Thus the selected sequence in the order of addition, where sulphuric acid is added to the mixture of the other reactants would lead to higher production of PMA in turn conducting to a faster reduction reaction. The resulting SIA method was validated finding limits of detection (3s/m) and quantification (10s/m) of 0.0077 and 0.026 mg-P L-1 respectively. Linearity was confirmed in the range up to 2 mg-P L-1. Precisions (sr, n = 10) were in the range 1.8%-4.0%. 32 water samples of different types and origins were analysed by the proposed method and by ion chromatography, obtaining a regression curve y = 0.990× - 0.0019, with a determination coefficient R2 = 0.973.

mRNA in exosomas as a liquid biopsy in non-Hodgkin Lymphoma: a multicentric study by the Spanish Lymphoma Oncology Group.

PURPOSE: To determine the feasibility of mRNAs (C-MYC, BCL-XL, BCL-6, NF-κß, PTEN and AKT) in exosomes of plasma as a liquid biopsy method for monitoring and prognostic evolution in B-cell lymphomas. PATIENTS AND METHODS: Exosomes were isolated from 98 patients with B-cell Lymphoma and 68 healthy controls. mRNAs were analyzed by quantitative PCR. An additional 31 post-treatment samples were also studied. RESULTS: In the general and follicular lymphoma series, the presence of AKT mRNA was associated with poor response to rituximab-based treatment. Patients with first relapse or disease progression showed a lower percentage of PTEN and BCL-XL mRNA. The presence of BCL-6 mRNA was associated with a high death rate. The absence of PTEN mRNA in the general series, and presence of C-MYC mRNA in follicular lymphomas, were associated with short progression-free survival. BCL-6 and C-MYC mRNA were independent prognostic variables of overall survival. C-MYC mRNA may provide prognostic information with respect to overall survival. BCL-XL mRNA and increase of BCL-6 mRNA in post-treatment samples could serve as molecular monitoring markers. CONCLUSIONS: This is the first large study to evaluate the prognostic and predictive values of pretreatment tumor-associated mRNA in exosomes. BCL-6 and C-MYC mRNA positivity in pretreatment samples were predictors of worse PFS compared to patients with mRNA negativity. C-MYC mRNA positivity was also a statistically significant predictor of inability to obtain complete response with first-line therapy.

Influencia de los cambios térmicos en la resistencia flexural de los acrílicos de ter-mocurado para la base de dentaduras con y sin insertos metálicos: Estudio in vitro / Influência das mudanças termicas na resistência a dos acrílicos de termo curva para base de dentaduras com e sem inserções de metal: Estudo in vitro / Influence emerged by termal changes in the flexural strength of heat polymerized acrylics used for denture bases, with and without metallic inserts. In vitro study

Objetivo: Determinar si los cambios de temperatura afectan a la resistencia flexural de los acrílicos de termocurado para la base de dentaduras con y sin insertos metálicos Materiales y métodos: Se elaboraron 80 muestras de acrílico de termocurado marca Veracril® según la especificación Nº12 de la American Dental Association (ADA) (10×65×25 mm); se conformaron cuatro gru-pos de 20 probetas, organizándolas de la siguiente manera Grupo 1: muestras sin realizar termociclado y sin inserto metálico. Grupo 2: muestras sometidas a termociclado y sin inserto metálico. Grupo 3: muestras sin realizar termociclado y con inserto metálico. Grupo 4 muestras sometidas a termociclado y con inserto metálico. Se realizaron 1000 ciclos termales mediante un procedimiento manual de 2 minutos por cada ciclo térmico, correspondiendo 1 minuto en temperatura de 5 ± 2 oC y 1 minuto a 55 ± 2 oC a un ciclo. La resistencia flexural se evaluó con una prueba de tres puntos a una velocidad de 1mm/min. El análisis estadístico fue a través de la prueba t de Student para muestras relacionadas con un nivel de significancia del 5%. Resultados: La media de resistencia flexural fue de 73.51, 65.65, 71.14 y 73.08 Megapascales (MPa)., para los grupos 1,2,3 y 4 respectivamente. Se observó que el G1 fue mayor que el G2 (p=0.002) y el G3 con el G4 no obtuvo valores con diferencia estadística significativa (p=0.554). Conclusión: Los cambios térmicos como procesos de envejecimiento del material influyen de forma negativa en la resistencia flexural de las muestras que en su estructura no presentaban inserto metálico, mientras que las muestras que poseían los insertos mejoraron la resistencia del material siendo esto estadísticamente comprobable.

Objective: The aim of this study was to determine if the different temperature changes affect in the flexural strength of the heat-cured acrylic for the base of dentures with and without metallic inserts by means of thermal cycling and flexion tests.Ma-terials and Methods: Eightysamples were prepared of a heat-cure acrylic Veracril® marque according to the specification no. Nº12 de la American Dental Association (ADA) (10×65×25 mm); Four groups of 20 buretteswere formed, each being Group 1: samples without realizing thermo cycling and without metallic insert. Group 2 for samples submitted to thermo cycling and wi-thout metallic insert. Group 3 for samples without thermo cycling and metallic insert in this structure. Group 4 samples submitted to thermo cycling and with metallic insert.1000 thermal cycles were realized by means of a manual procedure of 2 minutes by every thermal cycle, corresponding 1 minute in temperature of 5 ± 2 oC and 1 minute to 55 ± 2 oC to a cycle. The flexural resis-tance was evaluated by a test of three points at a speed of 1mm/min.The statistical analysis was through the Student t-test with a level of significance of 5%.Results: The mean flexural resistance was 73.51, 65.65, 71.14 and 73.08 MPa. For the groups 1,2,3 and 4 respectively. It was observed that G1 was greater than G2 (p = 0.002) and G3 with G4 did not obtain values with significant statistical difference (p = 0.554). Conclusion: The thermal changes as aging processes of the material negatively influence the flexural resistance of the samples which in their structure did not have a metallic insert improving the resistance of the material.

Objetivo: Determinar se a mudança de temperatura afeta, à resistência de flexão dos acrílicos de termo curvos para a base de den-taduras com e sem inserções metálicas. Materiais e métodos: elaboraram 80 amostras de acrílico curvo marca Veracril® segundo a especificação Nº12 da American Dental Association (ADA) (10×65×25 mm); conformaram-se quatro grupos de 20 provetas, organizando da seguinte maneira Grupo 1: amostras sem realizar termo ciclagem e sem inserção metálica. Grupo 2: amostras submetidas a termo ciclagem e sem inserção metálica. Grupo 3: amostras sem realizar termo ciclagem e com inserção metálica. Grupo 4 amostras submetidas a termo ciclagem e com inserção metálica. Realizaram-se 1000 ciclos termais mediante um procedi-mento manual de 2 minutos em cada ciclo térmico, correspondendo 1 minuto em temperatura de 5 ± 2 C e 1 minuto a 55 ± 2 C a um ciclo. A resistência de flexão se avaliou com uma prova de três pontos a uma velocidade de 1mm/min. A análise estadística foi através da prova t de Student para amostras relacionadas com um nível de significância de 5%. Resultados: A média de resistência de flexão foi de 73.51, 65.65, 71.14 e 73.08 Megapascales (MPa)., para os grupos 1,2,3 e 4 respetivamente. Observou-se que o G1 foi maior que e o G2 (p=0.002) e o G3 com o G4 não teve valores com diferença estadística significante (p=0.554). Conclusão: As mudanças térmicas como processos de envelhecimento do material influência de forma negativa na resistência de flexão das amostras que na sua estrutura não apresentavam inserção metálica, enquanto que as amostras que possuíam as inserções melho-raram a resistência do material sendo isto estatisticamente comprovável.

Exosomes enriched in stemness/metastatic-related mRNAS promote oncogenic potential in breast cancer.

Cancer cells efficiently transfer exosome contents (essentially mRNAs and microRNAs) to other cell types, modifying immune responses, cell growth, angiogenesis and metastasis. Here we analyzed the exosomes release by breast tumor cells with different capacities of stemness/metastasis based on CXCR4 expression, and evaluated their capacity to generate oncogenic features in recipient cells. Breast cancer cells overexpressing CXCR4 showed an increase in stemness-related markers, and in proliferation, migration and invasion capacities. Furthermore, recipient cells treated with exosomes from CXCR4-cells showed increased in the same abilities. Moreover, inoculation of CXCR4-cell-derived exosomes in immunocompromised mice stimulated primary tumor growth and metastatic potential. Comparison of nucleic acids contained into exosomes isolated from patients revealed a "stemness and metastatic" signature in exosomes of patients with worse prognosis. Finally, our data supported the view that cancer cells with stem-like properties show concomitant metastatic behavior, and their exosomes stimulate tumor progression and metastasis. Exosomes-derived nucleic acids from plasma of breast cancer patients are suitable markers in the prognosis of such patients.

Different exosome cargo from plasma/bronchoalveolar lavage in non-small-cell lung cancer.

Tumor-derived exosomes mediate tumorigenesis by facilitating tumor growth, metastasis, development of drug resistance, and immunosuppression. However, little is known about the exosomes isolated from bronchoalveolar lavage (BAL) in patients with lung neoplasm. Exosomes isolated in plasma and BAL from 30 and 75 patients with tumor and nontumor pathology were quantified by acetylcholinesterase activity and characterized by Western Blot, Electron Microscopy, and Nanoparticle Tracking Analysis. Differences in exosome cargo were analyzed by miRNA quantitative PCR in pooled samples and validated in a second series of patients. More exosomes were detected in plasma than in BAL in both groups (P < 0.001). The most miRNAs evaluated by PCR array were detected in tumor plasma, tumor BAL, and nontumor BAL pools, but only 56% were detected in the nontumor plasma pool. Comparing the top miRNAs with the highest levels detected in each pool, we found close homology only between the BAL samples of the two pathologies. In tumor plasma, we found a higher percentage of miRNAs with increased levels than in tumor BAL or in nontumor plasma. The data reveal differences between BAL and plasma exosome amount and miRNA content.

Protumorigenic effects of Snail-expression fibroblasts on colon cancer cells.

Snail1 is a transcriptional factor that plays an important role in epithelial-mesenchymal transition and in the acquisition of invasive properties by epithelial cells. In colon tumors, Snail1 expression in the stroma correlates with lower specific survival of cancer patients. However, the role(s) of Snail1 expression in stroma and its association with patients' survival have not been determined. We used human primary carcinoma-associated fibroblasts (CAFs) or normal fibroblasts (NFs) and fibroblast cell lines to analyze the effects of Snail1 expression on the protumorigenic capabilities in colon cancer cells. Snail1 expression was higher in CAFs than in NFs and, as well as α-SMA, a classic marker of activated CAFs. Moreover, in tumor samples from 50 colon cancer patients, SNAI1 expression was associated with expression of other CAF markers, such as α-SMA and fibroblast activation protein. Interestingly, coculture of CAFs with colon cells induced a significant increase in epithelial cell migration and proliferation, which was associated with endogenous SNAI1 expression levels. Ectopic manipulation of Snail1 in fibroblasts demonstrated that Snail1 expression controlled migration as well as proliferation of cocultured colon cancer cells in a paracrine manner. Furthermore, expression of Snail1 in fibroblasts was required for the coadjuvant effect of these cells on colon cancer cell growth and invasion when coxenografted in nude mice. Finally, cytokine profile changes, particularly MCP-3 expression, in fibroblasts are put forward as mediators of Snail1-derived effects on colon tumor cell migration. In summary, these studies demonstrate that Snail1 is necessary for the protumorigenic effects of fibroblasts on colon cancer cells.

Tumor-derived exosomes are enriched in ΔNp73, which promotes oncogenic potential in acceptor cells and correlates with patient survival.

Tumor-derived exosomes are emerging as local and systemic cell-to-cell mediators of oncogenic information through the horizontal transfer of mRNAs, microRNAs and proteins during tumorigenesis. The exosomal content has been described as biologically active when taken up by the recipient cell. Identifying the specific molecular cargo of exosomes will help to determine their function in specific steps of the tumorigenic process. Here we evaluate whether ΔNp73 is selectively packaged in tumor-derived exosomes, its function in the acceptor cells in vitro and in vivo and its prognosis potential in cancer. ΔNp73 messenger is enriched in tumor-derived exosomes, suggesting its active sorting in these microvesicles. We observed the transmission of this exosome cargo to different cell types and how it confers proliferation potential and chemoresistance to the acceptor cells in vitro and in animal models. Finally, our data support the potential prognostic value of exosomal ΔNp73 in colon cancer patients.