Is central venous catheter in haemodialysis still the main factor of mortality after hospitalization?

BACKGROUND: Haemodialysis is the most frequently prescribed Renal Replacement Therapy modality worldwide. However, patients undergoing this therapy have an unpredictable evolution related to vascular access. OBJECTIVE: To determine the factors associated with the mortality and hospitalization rate in haemodialysis patients at a third-level care Centre in the Dominican Republic. METHODS: This was an observational and prospective study involving a cohort of 192 haemodialysis patients. The patient selection was non-probabilistic for convenience, and a direct source questionnaire was applied. RESULTS: Of the 192 patients in the cohort, 103 (53.6%) were hospitalized and evaluated. The most frequent cause of hospitalization was catheter-related bloodstream infections (53.4%). Almost one-third (28.2%) of the hospitalized patients died, mostly due to infections (12.6%). Of those who died 29 patients (90%) had a Central venous catheter (CVC) with a non-tunnelled catheter (NTCVC) (65.5%); having an NTC CVC makes a patient 85.5 times more likely to be hospitalized than patients with arteriovenous fistulas. CONCLUSION: Vascular access plays a predominant role in the hospitalization and mortality rates in haemodialysis. Patients with an arteriovenous fistula obtained significantly better outcomes than those with central venous catheters.

Duodenal Pseudolipomatosis. Literature review and case report of a very unusual finding.

Pseudolipomatosis (PL) is a rare, benign, iatrogenic condition first described in colorectal mucosa. This condition is thought to arise from gas penetration into the mucosa due to mechanical or chemical injury during endoscopy. Despite these associations and its characteristic appearence, the definitive pathogenesis remains unclear and it continues to be underrecognized by some pathologists and endoscopists, which is crucial to avoid any further unnecessary treatments. Immunohistochemistry techniques play a role in differentiating PL from similar conditions such as cystic intestinal pneumatosis, intestinal lipomatosis, or lymphangiectasia. A 70-year-old man with a family history of colon adenocarcinoma was diagnosed with duodenal pseudolipomatosis after a routine endoscopic assessment. To the best of our knowledge, there have been only two reports of PL diagnosed in the duodenum. A review of over 500 duodenal biopsies at our centre revealed that no other instances were identified, emphasizing the unusual occurrence of this particular location.

Smartwatch: Looking beyond what you see.

BACKGROUND: The clinical utility of the Apple Inc.® smartwatch in scenarios beyond detecting atrial fibrillation has been debated. Although the device has the capability to record electrocardiograms (ECG) and detect arrhythmias, voltage limitations hinder its accuracy in measuring real voltage when recording precordial leads. This limitation poses challenges for its clinical use in diagnosing ischemia and screening cardiomyopathies. This review aims to analyze the ECG recording capacity of the Apple Watch, investigate the reasons for voltage limitations, and explore alternative approaches for its use in these clinical scenarios. METHODS: A comprehensive literature review was conducted to examine the ECG recording capacity of the Apple Watch and the limitations encountered when recording precordial leads. Data in CSV format files were analyzed to gain insights into the underlying causes of voltage limitations. RESULTS: The Apple Watch demonstrates effectiveness in detecting cardiac arrhythmias such as atrial fibrillation using photoplethysmography and ECG recording. However, voltage limitations during precordial lead recordings impede accurate voltage measurement, thereby limiting its clinical utility. Analysis of the data stored in the CSV files revealed that these voltage limitations are primarily attributed to the presentation format. Exploring alternative approaches for data processing could potentially overcome this challenge. CONCLUSIONS: This review highlights the potential for addressing voltage limitations through alternative data processing approaches. Further research is necessary to identify suitable alternatives that enable the Apple Watch to be effectively utilized in these clinical scenarios.

Key Stratification of Microbiota Taxa and Metabolites in the Host Metabolic Health-Disease Balance.

Human gut microbiota seems to drive the interaction with host metabolism through microbial metabolites, enzymes, and bioactive compounds. These components determine the host health-disease balance. Recent metabolomics and combined metabolome-microbiome studies have helped to elucidate how these substances could differentially affect the individual host pathophysiology according to several factors and cumulative exposures, such as obesogenic xenobiotics. The present work aims to investigate and interpret newly compiled data from metabolomics and microbiota composition studies, comparing controls with patients suffering from metabolic-related diseases (diabetes, obesity, metabolic syndrome, liver and cardiovascular diseases, etc.). The results showed, first, a differential composition of the most represented genera in healthy individuals compared to patients with metabolic diseases. Second, the analysis of the metabolite counts exhibited a differential composition of bacterial genera in disease compared to health status. Third, qualitative metabolite analysis revealed relevant information about the chemical nature of metabolites related to disease and/or health status. Key microbial genera were commonly considered overrepresented in healthy individuals together with specific metabolites, e.g., Faecalibacterium and phosphatidylethanolamine; and the opposite, Escherichia and Phosphatidic Acid, which is converted into the intermediate Cytidine Diphosphate Diacylglycerol-diacylglycerol (CDP-DAG), were overrepresented in metabolic-related disease patients. However, it was not possible to associate most specific microbiota taxa and metabolites according to their increased and decreased profiles analyzed with health or disease. Interestingly, positive association of essential amino acids with the genera Bacteroides were observed in a cluster related to health, and conversely, benzene derivatives and lipidic metabolites were related to the genera Clostridium, Roseburia, Blautia, and Oscillibacter in a disease cluster. More studies are needed to elucidate the microbiota species and their corresponding metabolites that are key in promoting health or disease status. Moreover, we propose that greater attention should be paid to biliary acids and to microbiota-liver cometabolites and its detoxification enzymes and pathways.

Topological and Multivalent Effects in Glycofullerene Oligomers as EBOLA Virus Inhibitors.

The synthesis of new biocompatible antiviral materials to fight against the development of multidrug resistance is being widely explored. Due to their unique globular structure and excellent properties, [60]fullerene-based antivirals are very promising bioconjugates. In this work, fullerene derivatives with different topologies and number of glycofullerene units were synthesized by using a SPAAC copper free strategy. This procedure allowed the synthesis of compounds 1-3, containing from 20 to 40 mannose units, in a very efficient manner and in short reaction times under MW irradiation. The glycoderivatives were studied in an infection assay by a pseudotyped viral particle with Ebola virus GP1. The results obtained show that these glycofullerene oligomers are efficient inhibitors of EBOV infection with IC50s in the nanomolar range. In particular, compound 3, with four glycofullerene moieties, presents an outstanding relative inhibitory potency (RIP). We propose that this high RIP value stems from the appropriate topological features that efficiently interact with DC-SIGN.

Exploring Next Generation Probiotics for Metabolic and Microbiota Dysbiosis Linked to Xenobiotic Exposure: Holistic Approach.

Variation of gut microbiota in metabolic diseases seems to be related to dysbiosis induced by exposure to multiple substances called Microbiota Disrupting Chemicals (MDCs), which are present as environmental and dietary contaminants. Some recent studies have focused on elucidating the alterations of gut microbiota taxa and their metabolites as a consequence of xenobiotic exposures to find possible key targets involved in the severity of the host disease triggered. Compilation of data supporting the triad of xenobiotic-microbiota-metabolic diseases would subsequently allow such health misbalances to be prevented or treated by identifying beneficial microbe taxa that could be Next Generation Probiotics (NGPs) with metabolic enzymes for MDC neutralisation and mitigation strategies. In this review, we aim to compile the available information and reports focused on variations of the main gut microbiota taxa in metabolic diseases associated with xenobiotic exposure and related microbial metabolite profiles impacting the host health status. We performed an extensive literature search using SCOPUS, Web of Science, and PubMed databases. The data retrieval and thorough analyses highlight the need for more combined metagenomic and metabolomic studies revealing signatures for xenobiotics and triggered metabolic diseases. Moreover, metabolome and microbiome compositional taxa analyses allow further exploration of how to target beneficial NGP candidates according to their alleged variability abundance and potential therapeutic significance. Furthermore, this holistic approach has identified limitations and the need of future directions to expand and integrate key knowledge to design appropriate clinical and interventional studies with NGPs. Apart from human health, the beneficial microbes and metabolites identified could also be proposed for various applications under One Health, such as probiotics for animals, plants and environmental bioremediation.

Meeting Treatment Goals in Patients on Extramural Dialysis in Health Social Security in Mexico.

INTRODUCTION: For the majority of renal replacement therapy history, the main treatment option for patients with end-stage renal disease (ESRD) in Mexico has been peritoneal dialysis. However, the use of hemodialysis is overwhelmingly increasing, driving public health care institutions to subrogate this service. Even when the actual hiring model for subrogation is accurate, there is a lack of quality control points in the hemodialysis prescription, poor adherence to clinical practice guidelines, and a few or no record of outcomes in hemodialysis patients of these subrogated services. The objective of this work is to fill this information gap to allow for uniform and safe hemodialysis for patients of Mexico. MATERIAL AND METHODS: An observational and cross-sectional study was performed, including all patients receiving chronic hemodialysis treatment in subrogated units of Mexican Social Security Institute (IMSS) in the northern region of Mexico City. Clinical and biochemical data as well as hemodialysis dose by Kt/V and urea reduction rate were collected and evaluated. To determine distribution, mean or median and SD or interquartile range were used; for nominal variables, the difference in proportions was estimated using the χ2 test; proportions were analyzed for biochemical values using the statistical package SPSS version 25. RESULTS: In our study, >60% (485) of the patients were anemic with an average hemoglobin of 9.39 mg/dL (SD ± 1.83); serum calcium was found below 8.4 mg/dL in 51.3% (383) of patients, and only in 45.8% (342) was at an optimal level of this parameter. Only 33.5% of patients have arteriovenous fistula for dialysis access. The hemodialysis dose was optimal in >75% of patients. CONCLUSIONS: It is necessary to enhance and monitor treatment of comorbidities in patients with ESRD in subrogated hemodialysis units in México. We observed adequate prescription of hemodialysis in a majority of patients, achieving quality control points for removal of nitrogen products. Yet, there is a lack of quality control of comorbidities; therefore, we should aim to optimize treatment for mineral-bone disorder, anemia, and nutritional status.

Representative Bacillus sp. AM1 from Gut Microbiota Harbor Versatile Molecular Pathways for Bisphenol A Biodegradation.

Human gut microbiota harbors numerous microbial species with molecular enzymatic potential that impact on the eubiosis/dysbiosis and health/disease balances. Microbiota species isolation and description of their specific molecular features remain largely unexplored. In the present study, we focused on the cultivation and selection of species able to tolerate or biodegrade the endocrine disruptor bisphenol A (BPA), a xenobiotic extensively found in food plastic containers. Chemical xenobiotic addition methods for the directed isolation, culturing, Whole Genome Sequencing (WGS), phylogenomic identification, and specific gene-encoding searches have been applied to isolate microorganisms, assess their BPA metabolization potential, and describe encoded catabolic pathways. BPA-tolerant strains were isolated from 30% of infant fecal microbial culture libraries analyzed. Most isolated strains were phylogenetically related to the operational taxonomic group Bacillus amyloliquefaciens spp. Importantly, WGS analysis of microbial representative strain, Bacillus sp. AM1 identified the four complete molecular pathways involved on BPA degradation indicating its versatility and high potential to degrade BPA. Pathways for Exopolysaccharide (EPS) and Polyhydroxyalkanates (PHA) biopolymer synthesis were also identified and phenotypically confirmed by transmission electronic microscopy (TEM). These microbial biopolymers could generally contribute to capture and/or deposit xenobiotics.

An Ultra-Long-Lived Triplet Excited State in Water at Room Temperature: Insights on the Molecular Design of Tridecafullerenes.

Suitably engineered molecular systems exhibiting triplet excited states with very long lifetimes are important for high-end applications in nonlinear optics, photocatalysis, or biomedicine. We report the finding of an ultra-long-lived triplet state with a mean lifetime of 93 ms in an aqueous phase at room temperature, measured for a globular tridecafullerene with a highly compact glycodendrimeric structure. A series of three tridecafullerenes bearing different glycodendrons and spacers to the C60 units have been synthesized and characterized. UV/Vis spectra and DLS experiments confirm their aggregation in water. Steady-state and time-resolved fluorescence experiments suggest a different degree of inner solvation of the multifullerenes depending on their molecular design. Efficient quenching of the triplet states by O2 but not by waterborne azide anions has been observed. Molecular modelling reveals dissimilar access of the aqueous phase to the internal structure of the tridecafullerenes, differently shielded by the glycodendrimeric shell.

Nanocarbon-Based Glycoconjugates as Multivalent Inhibitors of Ebola Virus Infection.

SWCNTs, MWCNTs, and SWCNHs have been employed as virus-mimicking nanocarbon platforms for the multivalent presentation of carbohydrates in an artificial Ebola virus infection model assay. These carbon nanoforms have been chemically modified by the covalent attachment of glycodendrons and glycofullerenes using the CuAAC "click chemistry" approach. This modification dramatically increases the water solubility of these structurally different nanocarbons. Their efficiency in blocking DC-SIGN-mediated viral infection by an artificial Ebola virus has been tested in a cellular experimental assay, finding that glycoconjugates based on MWCNTs functionalized with glycofullerenes are potent inhibitors of viral infection.

Short-medium-long-term efficacy of interdisciplinary intervention against overweight and obesity: Randomized controlled clinical trial.

AIM: The aim of the study is to evaluate the efficacy of a nurse-led interdisciplinary programme based on healthy eating, physical exercise, and cognitive behavioural therapy applied to anthropometric and cardiovascular measures, which are related to obesity in short, medium, and long term. METHODS: We conducted a randomised controlled clinical trial with 74 obese and overweight participants (experimental group, n = 37; control group, n = 37). An interdisciplinary programme of 12 months was applied and coordinated by a nurse. Anthropometric and cardiovascular measures were taken at the pretest stage, every 6 months during the programme, and 1 year after it finished. RESULTS: A beneficial effect was found regarding all anthropometric parameters. Tests for weight (F3;207  = 93.27; P < .001) and body mass index (F3;207  = 89.95; P < .001) indicate efficacy of intervention: The experimental group had a weight loss of 7.2 kg (-8.3%) compared to a 0.9 kg (+1.0%) gained in the control group. Systolic (F3;207  = 37.06; P < .001) and diastolic (F3;216  = 57.31; P < .001) blood pressure improved greatly in the experimental group. Forced vital capacity was also increased (F2;138  = 15.51; P < .001). CONCLUSION: The interdisciplinary programme coordinated by nurses improved the health of participants, maintaining long-term effects.

Impact of the I2AO2 interdisciplinary program led by nursing on psychological comorbidity and quality of life: Randomized controlled clinical trial.

OBJECTIVE: Obesity is an entity of highly prevalent multifactorial origin with associated metabolic and psychological comorbidity, causing a negative impact on the quality of life of those who suffer from it. The objective is to evaluate the impact of an interdisciplinary program for nurse-led obesity on quality of life related to health and anxiety. METHODS: Randomized controlled clinical trial with a sample of 74 subjects diagnosed with obesity (EG: n=37; CG: n=37). The intervention consisted of a 12-month interdisciplinary program (with pre-test, 12month and 24month follow-up) coordinated by nurses. RESULTS: The anxiety analysis shows that there is no effect of the intervention on S-STAI (F2; 144=0.246; p=0.782), which has increased in both groups. However, there is an effect on T-STAI (F2; 144=8872; p<0.001), which only increases in the control group. The interdisciplinary program has significantly improved health-related quality of life (SF-36), both in physical health parameters as well as in mental health. CONCLUSION: The interdisciplinary program led by nursing professionals has improved the quality of life related to health and has prevented the increase of anxiety-trait in participants, maintaining the long-term effects.

Bacterial cell cycle classification. Application to DNA synthesis and DNA content at any cell age.

A proposal is presented for classifying bacterial cell cycles into twelve discrete groups. This classification translates the three temporal parameters that define a cell cycle into numbers that facilitate an algorithmic approach to analyse the replication state of a single bacterium and of a bacterial population during steady-state of exponential growth. The classification and its implementation offer easy ways to obtain the rate of DNA synthesis and the amount of DNA per cell at any age in batch cultures.

Phosphoenolpyruvate carboxylase (PEPC) and PEPC-kinase (PEPC-k) isoenzymes in Arabidopsis thaliana: role in control and abiotic stress conditions.

MAIN CONCLUSION: Arabidopsis ppc3 mutant has a growth-arrest phenotype and is affected in phosphate- and salt-stress responses, showing that this protein is crucial under control or stress conditions. Phosphoenolpyruvate carboxylase (PEPC) and its dedicated kinase (PEPC-k) are ubiquitous plant proteins implicated in many physiological processes. This work investigates specific roles for the three plant-type PEPC (PTPC) and the two PEPC-k isoenzymes in Arabidopsis thaliana. The lack of any of the PEPC isoenzymes reduced growth parameters under optimal growth conditions. PEPC activity was decreased in shoots and roots of ppc2 and ppc3 mutants, respectively. Phosphate starvation increased the expression of all PTPC and PPCK genes in shoots, but only PPC3 and PPCK2 in roots. The absence of any of these two proteins was not compensated by other isoforms in roots. The effect of salt stress on PTPC and PPCK expression was modest in shoots, but PPC3 was markedly increased in roots. Interestingly, both stresses decreased root growth in each of the mutants except for ppc3. This mutant had a stressed phenotype in control conditions (reduced root growth and high level of stress molecular markers), but was unaffected in their response to high salinity. Salt stress increased PEPC activity, its phosphorylation state, and L-malate content in roots, all these responses were abolished in the ppc3 mutant. Our results highlight the importance of the PPC3 isoenzyme for the normal development of plants and for root responses to stress.

Neuroendocrinology of childbirth and mother-child attachment: the basis of an etiopathogenic model of perinatal neurobiological disorders.

This review focuses on the neuroendocrine mechanisms in the mother and the newborn that are involved in the generation and consolidation of mother-child attachment. The role that different hormones and neurotransmitters play on the regulation of these mechanisms during parturition, the immediate postpartum period and lactation is discussed. Interferences in the initiation of mother-child attachment may have potential long-term effects for the behavior and affection of the newborn. Therefore, the possible consequences of alterations in the physiological neuroendocrine mechanisms of attachment, caused by elective Cesarean section, intrapartum hormonal manipulations, preterm delivery, mother-infant postpartum separation and bottle-feeding instead of breastfeeding are also discussed.

Chromosome replication status and DNA content at any cell age in a bacterial cell cycle.

An algorithm is presented to determine the chromosome replication status, the rate of DNA synthesis per fork, and the amount of DNA in chromosome equivalents (G) per chromosome, per cell and per age throughout a bacterial cell cycle. This algorithm is the only attempt to study replication and the G value at any cell age since the general model of the bacterial cell cycle by Cooper and Helmstetter (1968, J. Mol. Biol. 31, 619-644). To help using it, two implementations are provided.

Reversal of PCNA ubiquitylation by Ubp10 in Saccharomyces cerevisiae.

Regulation of PCNA ubiquitylation plays a key role in the tolerance to DNA damage in eukaryotes. Although the evolutionary conserved mechanism of PCNA ubiquitylation is well understood, the deubiquitylation of ubPCNA remains poorly characterized. Here, we show that the histone H2B(K123) ubiquitin protease Ubp10 also deubiquitylates ubPCNA in Saccharomyces cerevisiae. Our results sustain that Ubp10-dependent deubiquitylation of the sliding clamp PCNA normally takes place during S phase, likely in response to the simple presence of ubPCNA. In agreement with this, we show that Ubp10 forms a complex with PCNA in vivo. Interestingly, we also show that deletion of UBP10 alters in different ways the interaction of PCNA with DNA polymerase ζ-associated protein Rev1 and with accessory subunit Rev7. While deletion of UBP10 enhances PCNA-Rev1 interaction, it decreases significantly Rev7 binding to the sliding clamp. Finally, we report that Ubp10 counteracts Rad18 E3-ubiquitin ligase activity on PCNA at lysine 164 in such a manner that deregulation of Ubp10 expression causes tolerance impairment and MMS hypersensitivity.

Placental fatty acid transfer: a key factor in fetal growth.

The functionality of the placenta may affect neonatal adiposity and fetal levels of key nutrients such as long-chain polyunsaturated fatty acids. Fetal macrosomia and its complications may occur even in adequately controlled gestational diabetic (GDM) mothers, suggesting that maternal glycemia is not the only determinant of fetal glycemic status and wellbeing. We studied in vivo the placental transfer of fatty acids (FA) labeled with stable isotopes administered to 11 control and 9 GDM pregnant women (6 treated with insulin). Subjects received orally ¹³C-palmitic, ¹³C-oleic, and ¹³C-linoleic acids and ¹³C-docosahexaenoic acid (¹³C-DHA) 12 h before an elective caesarean section. FA were quantified by gas chromatography and ¹³C enrichments by gas chromatography-isotope ratio mass spectrometry. The ¹³C-FA concentration was higher in total lipids of maternal plasma in GDM patients versus controls, except for ¹³C-DHA. Moreover, ¹³C-DHA showed a lower placenta/maternal plasma ratio in GDM patients versus controls and a significantly lower cord/maternal plasma ratio. Other FA ratios studied were not different between GDM and controls. A disturbed ¹³C-DHA placental uptake occurred in GDM patients treated with diet or insulin, while the latter also had lower ¹³C-DHA levels in the venous cord. The tracer study pointed towards an impaired placental DHA uptake as a critical step, while the transfer of other ¹³C-FA was less affected. Patients with GDM treated with insulin could also have a greater fetal fat storage, which may have contributed to the reduced ¹³C-DHA in the venous cord observed. The DHA transfer to the fetus was reduced in GDM pregnancies compared to controls. This might have an influence on fetal neurodevelopment and long-term consequences for the child.

Surgical correction of horizontal bone defect using the lateral maxillary wall: outcomes of a retrospective study.

PURPOSE: To report on the outcomes of a new surgical technique for the treatment of severe horizontal bone resorption that impedes the placement of dental implants. MATERIALS AND METHODS: Eleven patients in need of bone augmentation to reconstruct a narrow alveolar ridge were recruited for the present study. Surgical correction of the alveolar width was performed by harvesting an onlay bone graft from the lateral wall of the maxillary sinus and filling the intervening space with plasma rich in growth factors alone or mixed with autologous bone particles. A fibrin membrane was then placed to cover the surgical site before flap closure. Clinical examinations and cone-beam computed tomography were performed to analyze the safety and efficiency of an onlay bone graft from the maxilla in horizontal bone augmentation. RESULTS: The present study is the first to describe the lateral wall of the maxillary sinus as a donor site for an onlay bone graft. The healing period was uneventful, with minimal surgical morbidity. No flap exposure occurred, and analysis of the cone-beam computed tomography scans before and after (about 5 months) bone augmentation revealed a total gain of 5.4 mm in alveolar width. This permitted the placement of dental implants to support an implant-borne prosthesis. CONCLUSIONS: An onlay bone graft from the lateral wall of the maxillary sinus is a useful and safe tool for horizontal bone augmentation with minimal surgical morbidity.

In vitro fracture resistance of mandibular incisors restored with modified partial-coverage ceramic restorations.

BACKGROUND/AIM: The aim of this in vitro study was to investigate the impact fracture resistance of anterior teeth that had been fractured and restored with modified partial-coverage ceramics using the edge-up technique. MATERIAL AND METHODS: A total of 178 extracted human mandibular central and lateral incisors were included in this study. The incisors were randomly divided into two groups. Group 1 (n = 89) teeth were cleaved and restored with modified partial-coverage ceramics using the edge-up technique; Group 2 (n = 89) consisted of intact teeth that served as control. Impact strength was tested in a modified impact testing machine (pendulum type), and the severity of crown fracture after fracture resistance test was registered. RESULTS: Impact strength was insignificantly lower in restored teeth (median 5.39 and range 0.81-14.12 kJ m(-2) ) than in intact teeth (median 5.45 and range 0.31-16.47 kJ m(-2) ), although no statistically significant differences were observed. Regarding the severity of crown fracture, restored teeth showed a lower rate of severe fractures (20.22%) compared to intact teeth (25.84%), but no statistically significant differences were observed. CONCLUSIONS: Restoration of cleaved mandibular incisors with modified partial-coverage ceramics using the edge-up technique shows fracture resistance and severity of crown fracture following traumatism similar to intact teeth. In this way, this technique can be used successfully for the treatment of fractured anterior teeth.