Influence of Chronic Obstructive Pulmonary Disease and Moderate-To-Severe Sleep Apnoea in Overnight Cardiac Autonomic Modulation: Time, Frequency and Non-Linear Analyses.

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent lung diseases worldwide. COPD patients show major dysfunction in cardiac autonomic modulation due to sustained hypoxaemia, which has been significantly related to higher risk of cardiovascular disease. Obstructive sleep apnoea syndrome (OSAS) is a frequent comorbidity in COPD patients. It has been found that patients suffering from both COPD and OSAS simultaneously, the so-called overlap syndrome, have notably higher morbidity and mortality. Heart rate variability (HRV) has demonstrated to be useful to assess changes in autonomic functioning in different clinical conditions. However, there is still little scientific evidence on the magnitude of changes in cardiovascular dynamics elicited by the combined effect of both respiratory diseases, particularly during sleep, when apnoeic events occur. In this regard, we hypothesised that a non-linear analysis is able to provide further insight into long-term dynamics of overnight cardiovascular modulation. Accordingly, this study is aimed at assessing the usefulness of sample entropy (SampEn) to distinguish changes in overnight pulse rate variability (PRV) recordings among three patient groups while sleeping: COPD, moderate-to-severe OSAS, and overlap syndrome. In order to achieve this goal, a population composed of 297 patients were studied: 22 with COPD alone, 213 showing moderate-to-severe OSAS, and 62 with COPD and moderate-to-severe OSAS simultaneously (COPD+OSAS). Cardiovascular dynamics were analysed using pulse rate (PR) recordings from unattended pulse oximetry carried out at patients' home. Conventional time- and frequency- domain analyses were performed to characterise sympathetic and parasympathetic activation of the nervous system, while SampEn was applied to quantify long-term changes in irregularity. Our analyses revealed that overnight PRV recordings from COPD+OSAS patients were significantly more irregular (higher SampEn) than those from patients with COPD alone (0.267 [0.210-0.407] vs. 0.212 [0.151-0.267]; p < 0.05) due to recurrent apnoeic events during the night. Similarly, COPD + OSAS patients also showed significantly higher irregularity in PRV during the night than subjects with OSAS alone (0.267 [0.210-0.407] vs. 0.241 [0.189-0.325]; p = 0.05), which suggests that the cumulative effect of both diseases increases disorganization of pulse rate while sleeping. On the other hand, no statistical significant differences were found between COPD and COPD + OSAS patients when traditional frequency bands (LF and HF) were analysed. We conclude that SampEn is able to properly quantify changes in overnight cardiovascular dynamics of patients with overlap syndrome, which could be useful to assess cardiovascular impairment in COPD patients due to the presence of concomitant OSAS.

Corrigendum to "Decoding phenotypic screening: A comparative analysis of image representations" [Computat Struct Biotechnol J 23 (2024) 1181-1188].

[This corrects the article DOI: 10.1016/j.csbj.2024.02.022.].

Decoding phenotypic screening: A comparative analysis of image representations.

Biomedical imaging techniques such as high content screening (HCS) are valuable for drug discovery, but high costs limit their use to pharmaceutical companies. To address this issue, The JUMP-CP consortium released a massive open image dataset of chemical and genetic perturbations, providing a valuable resource for deep learning research. In this work, we aim to utilize the JUMP-CP dataset to develop a universal representation model for HCS data, mainly data generated using U2OS cells and CellPainting protocol, using supervised and self-supervised learning approaches. We propose an evaluation protocol that assesses their performance on mode of action and property prediction tasks using a popular phenotypic screening dataset. Results show that the self-supervised approach that uses data from multiple consortium partners provides representation that is more robust to batch effects whilst simultaneously achieving performance on par with standard approaches. Together with other conclusions, it provides recommendations on the training strategy of a representation model for HCS images.

An Insertion Within SIRPß1 Shows a Dual Effect Over Alzheimer's Disease Cognitive Decline Altering the Microglial Response.

Background: Microglial dysfunction plays a causative role in Alzheimer's disease (AD) pathogenesis. Here we focus on a germline insertion/deletion variant mapping SIRPß1, a surface receptor that triggers amyloid-ß(Aß) phagocytosis via TYROBP. Objective: To analyze the impact of this copy-number variant in SIRPß1 expression and how it affects AD molecular etiology. Methods: Copy-number variant proxy rs2209313 was evaluated in GERALD and GR@ACE longitudinal series. Hippocampal specimens of genotyped AD patients were also examined. SIRPß1 isoform-specific phagocytosis assays were performed in HEK393T cells. Results: The insertion alters the SIRPß1 protein isoform landscape compromising its ability to bind oligomeric Aß and its affinity for TYROBP. SIRPß1 Dup/Dup patients with mild cognitive impairment show an increased cerebrospinal fluid t-Tau/Aß ratio (p = 0.018) and a higher risk to develop AD (OR = 1.678, p = 0.018). MRIs showed that Dup/Dup patients exhibited a worse initial response to AD. At the moment of diagnosis, all patients showed equivalent Mini-Mental State Examination scores. However, AD patients with the duplication had less hippocampal degeneration (p < 0.001) and fewer white matter hyperintensities. In contrast, longitudinal studies indicate that patients bearing the duplication allele show a slower cognitive decline (p = 0.013). Transcriptional analysis also shows that the SIRPß1 duplication allele correlates with higher TREM2 expression and an increased microglial activation. Conclusions: The SIRPß1 internal duplication has opposite effects over MCI-to-Dementia conversion risk and AD progression, affecting microglial response to Aß. Given the pharmacological approaches focused on the TREM2-TYROBP axis, we believe that SIRPß1 structural variant might be considered as a potential modulator of this causative pathway.

CLOOME: contrastive learning unlocks bioimaging databases for queries with chemical structures.

The field of bioimage analysis is currently impacted by a profound transformation, driven by the advancements in imaging technologies and artificial intelligence. The emergence of multi-modal AI systems could allow extracting and utilizing knowledge from bioimaging databases based on information from other data modalities. We leverage the multi-modal contrastive learning paradigm, which enables the embedding of both bioimages and chemical structures into a unified space by means of bioimage and molecular structure encoders. This common embedding space unlocks the possibility of querying bioimaging databases with chemical structures that induce different phenotypic effects. Concretely, in this work we show that a retrieval system based on multi-modal contrastive learning is capable of identifying the correct bioimage corresponding to a given chemical structure from a database of ~2000 candidate images with a top-1 accuracy >70 times higher than a random baseline. Additionally, the bioimage encoder demonstrates remarkable transferability to various further prediction tasks within the domain of drug discovery, such as activity prediction, molecule classification, and mechanism of action identification. Thus, our approach not only addresses the current limitations of bioimaging databases but also paves the way towards foundation models for microscopy images.

Evaluation of Different Natural Ventilation Strategies by Monitoring the Indoor Air Quality Using CO2 Sensors.

Indoor air quality is a characteristic that depends on air pollutants inside a building and that can be affected by different ventilation strategies. There is strong evidence linking poor indoor air quality (IAQ) and harmful health effects, especially on vulnerable collectives, such as children in schools. Due to this concern, this work aims to provide guidance on the design of highly efficient ventilation strategies to improve the air quality of schools' classrooms. For this, IAQ monitoring has been carried out in eight educational in real conditions centres using CO2 concentration as an IAQ indicator. Variables such as the presence of students and their number, activity developed in the classroom and ventilation strategy used together with break time duration have been also recorded to analyse their influence on CO2 concentration levels. Concluding results have allowed us to determine the maximum number of students allowed in a closed room to maintain CO2 levels at normal concentrations and the time needed to reduce these CO2 levels depending on the ventilation strategy adopted. Moreover, it has been discussed how surrounding school conditions (pollution or noise) and the building isolation are impacting the final IAQ in the classrooms studied.

Effect of Nordic Sensi® Chair on Behavioral and Psychological Symptoms of Dementia in Nursing Homes Residents: A Randomized Controlled Trial.

BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are present in most people with dementia (PwD), including Alzheimer's disease. There is consensus that non-pharmacological therapies represent the first line of treatment to address BPSD. OBJECTIVE: We explore the efficacy of the use of a rocking chair (Nordic Sensi® Chair, NSC) in the treatment of BPSD in nursing home residents with moderate and severe dementia. METHODS: We carried out a 16-week randomized, single-blind, controlled, clinical trial with PwD admitted to nursing homes. Participants were assigned to a treatment group (n = 40) that received three times a week one session per day of 20 minutes in the NSC and a control group (n = 37). The Neuropsychiatric Inventory-Nursing Home (NPI-NH) was used as primary efficacy outcome. Occupational distress for the staff was evaluated using the NPI-NH Occupational Disruptiveness subscale (NPI-NH-OD). Statistical analyses were conducted by means of a Mixed Effects Model Analysis. RESULTS: Treatment with the NSC was associated with a beneficial effect in most of BPSD, as reflected by differences between the treatment and control group on the NPI-NH total score (mean change score -18.87±5.56 versus -1.74±0.67, p = 0.004), agitation (mean change score -2.32±2.02 versus -0.78±1.44, p = 0.003) and irritability (mean change score -3.35±2.93 versus -1.42±1.31, p = 0.004). The NPI-NH-OD total score also improved the most in the treatment group (mean change score -9.67±7.67 versus -7.66±6.08, p = 0.003). CONCLUSIONS: The reduction in overall BPSD along with decreased caregiver occupational disruptiveness represent encouraging findings, adding to the potential of nonpharmacological interventions for nursing home residents living with dementia.

Multicentre study on the accuracy of lung ultrasound in the diagnosis and monitoring of respiratory sequelae in the medium and long term in patients with COVID-19.

Introduction: Lung ultrasound (LUS) has proven to be a more sensitive tool than radiography (X-ray) to detect alveolar-interstitial involvement in COVID-19 pneumonia. However, its usefulness in the detection of possible pulmonary alterations after overcoming the acute phase of COVID-19 is unknown. In this study we proposed studying the utility of LUS in the medium- and long-term follow-up of a cohort of patients hospitalized with COVID-19 pneumonia. Materials and methods: This was a prospective, multicentre study that included patients, aged over 18 years, at 3 ± 1 and 12 ± 1 months after discharge after treatment for COVID-19 pneumonia. Demographic variables, the disease severity, and analytical, radiographic, and functional clinical details were collected. LUS was performed at each visit and 14 areas were evaluated and classified with a scoring system whose global sum was referred to as the "lung score." Two-dimensional shear wave elastography (2D-SWE) was performed in 2 anterior areas and in 2 posterior areas in a subgroup of patients. The results were compared with high-resolution computed tomography (CT) images reported by an expert radiologist. Results: A total of 233 patients were included, of whom 76 (32.6%) required Intensive Care Unit (ICU) admission; 58 (24.9%) of them were intubated and non-invasive respiratory support was also necessary in 58 cases (24.9%). Compared with the results from CT images, when performed in the medium term, LUS showed a sensitivity (S) of 89.7%, specificity (E) 50%, and an area under the curve (AUC) of 78.8%, while the diagnostic usefulness of X-ray showed an S of 78% and E of 47%. Most of the patients improved in the long-term evaluation, with LUS showing an efficacy with an S of 76% and E of 74%, while the X-ray presented an S of 71% and E of 50%. 2D-SWE data were available in 108 (61.7%) patients, in whom we found a non-significant tendency toward the presentation of a higher shear wave velocity among those who developed interstitial alterations, with a median kPa of 22.76 ± 15.49) versus 19.45 ± 11.39; p = 0.1). Conclusion: Lung ultrasound could be implemented as a first-line procedure in the evaluation of interstitial lung sequelae after COVID-19 pneumonia.

WNT Signaling in Tumors: The Way to Evade Drugs and Immunity.

WNT/ß-catenin signaling is involved in many physiological processes. Its implication in embryonic development, cell migration, and polarization has been shown. Nevertheless, alterations in this signaling have also been related with pathological events such as sustaining and proliferating the cancer stem cell (CSC) subset present in the tumor bulk. Related with this, WNT signaling has been associated with the maintenance, expansion, and epithelial-mesenchymal transition of stem cells, and furthermore with two distinctive features of this tumor population: therapeutic resistance (MDR, multidrug resistance) and immune escape. These mechanisms are developed and maintained by WNT activation through the transcriptional control of the genes involved in such processes. This review focuses on the description of the best known WNT pathways and the molecules involved in them. Special attention is given to the WNT cascade proteins deregulated in tumors, which have a decisive role in tumor survival. Some of these proteins function as extrusion pumps that, in the course of chemotherapy, expel the drugs from the cells; others help the tumoral cells hide from the immune effector mechanisms. Among the WNT targets involved in drug resistance, the drug extrusion pump MDR-1 (P-GP, ABCB1) and the cell adhesion molecules from the CD44 family are highlighted. The chemokine CCL4 and the immune checkpoint proteins CD47 and PD-L1 are included in the list of WNT target molecules with a role in immunity escape. This pathway should be a main target in cancer therapy as WNT signaling activation is essential for tumor progression and survival, even in the presence of the anti-tumoral immune response and/or antineoplastic drugs. The appropriate design and combination of anti-tumoral strategies, based on the modulation of WNT mediators and/or protein targets, could negatively affect the growth of tumoral cells, improving the efficacy of these types of therapies.

[Acute respiratory failure immediately following surgery for morbid obesity]. / Insuficiencia respiratoria aguda en el postoperatorio inmediato de cirugía por obesidad mórbida.

Patients with sleep apnea-hypopnea syndrome have a higher probability of presenting more postoperative complications, yet early treatment with continuous positive airway pressure can prevent them. We report the case of a patient who underwent surgery for morbid obesity and who developed acute respiratory failure in the immediate postoperative period, requiring readmission to the recovery unit. The patient's condition progressed favorably following treatment with bilevel positive airway pressure. It was subsequently confirmed that the patient suffered from sleep apnea-hypopnea syndrome.

[Professional quality of life in the clinical governance model of Asturias (Spain)]. / Calidad de vida de los profesionales en el modelo de gestión clínica de Asturias.

OBJECTIVE: To evaluate professional quality of life in our clinical governance model by comparing differences according to the time since the model's implementation (1-3 years) and the setting (primary or hospital care). METHODS: A cross-sectional descriptive study was performed. The 35-item, anonymous, self-administered Professional Quality of Life Questionnaire, with three additional questions, was applied. A minimum sample size for each clinical governance unit/area (CGU/CGA) was calculated. Descriptive, univariate and bivariate analyses were performed using the 35 items separately. The subscales of « management support ¼, « workload ¼ and « intrinsic motivation ¼ were used as dependant variables, and the setting and time since implementation of the CGU/CGA as independent variables. RESULTS: Of the study population of 2572 professionals, 1395 (54%) responded (67% in primary care and 51% in hospital care). A total of 87% had been working for 5 years or more in their positions. Thirty-three percent had worked for less than a year in clinical governance. The item with the highest score was job training (8.39 ± 1.42) and that with the lowest was conflicts with peers (3.23 ± 2.2). Primary healthcare professionals showed better results in management support and quality of life at work and hospital professionals in workload. The clinical governance model obtained the best scores at 3 years and the worst at 1 year. These differences were especially favorable for clinical governance in hospitals: professionals working longer perceived a lower workload and more intrinsic motivation and quality of life. CONCLUSIONS: A longer time working in the clinical governance model was associated with better perception of professional quality of life, especially in hospital care.

[Genitourinary and osteoarticular tuberculosis (Pott's disease)]. / Tuberculosis genitourinaria y osteoarticular (Mal de Pott).

OBJECTIVE: We present the case of a patient with urogenital and osteoarticular tuberculosis METHODS: Patient with end stage renal disease on hemodyalisis in study for fever of unknown origin. Multiple diagnostic tests were performed. RESULTS: Medical treatment for tuberculosis was given with improvement of the symptoms. CONCLUSION: The early urogram study can be crucial in the diagnosis of urogenital tuberculosis in initial stages, thus avoiding the progressive deterioration of kidney function.

Impacto del tiempo entre la extracción y el análisis de la gasometría arterial en la práctica clínica / The Effect Of Time Between Sample Extraction And Arterial Blood Gas Analysis In Clinical Practice

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Calidad de vida de los profesionales en el modelo de gestión clínica de Asturias / Professional quality of life in the clinical governance model of Asturias (Spain)

Objetivo: Analizar la calidad de vida profesional en el modelo de gestión clínica de Asturias y comprobar si hay diferencias en los centros donde el modelo lleva implantado más tiempo o en función del ámbito asistencial (atención primaria o especializada). Métodos: Se aplicó el CVP-35 (35 preguntas), anónimo y autocumplimentado, con tres preguntas adicionales. Se realizó un análisis descriptivo, univariado y bivariado, de las preguntas por separado y según las subescalas "Apoyo directivo" (AD), "Cargas de trabajo" (CT) y "Motivación intrínseca" (MI), siendo las principales variables independientes el ámbito asistencial y el tiempo como unidad o área de gestión clínica. Resultados: De la población de estudio, 2572 profesionales, respondieron 1395 (54%) (el 67% en primaria y 51% en especializada). El 87% llevaba 5 años o más en su puesto. Para el 33% era su primer año en gestión clínica. El ítem con mayor puntuación fue la capacitación para el trabajo (8,39 ± 1,42) y el más bajo los conflictos con los compañeros (3,23 ± 2,2). Primaria obtiene resultados más altos en AD y calidad de vida en el trabajo, y especializada en CT. Respecto a la gestión clínica, las mejores puntuaciones se obtienen en las de 3 años y las peores en las de primer año. Las diferencias son especialmente favorables a la gestión clínica en especializada: las que más tiempo llevan perciben menos CT y más MI y calidad de vida. Conclusiones: Llevar más tiempo en el modelo de gestión clínica se asocia con mejores percepciones en la calidad de vida profesional, sobre todo en atención especializada (AU)

Objective: To evaluate professional quality of life in our clinical governance model by comparing differences according to the time since the model's implementation (1-3 years) and the setting (primary or hospital care). Methods: A cross-sectional descriptive study was performed. The 35-item, anonymous, self-administered Professional Quality of Life Questionnaire, with three additional questions, was applied. A minimum sample size for each clinical governance unit/area (CGU/CGA) was calculated. Descriptive, univariate and bivariate analyses were performed using the 35 items separately. The subscales of "management support", "workload" and "intrinsic motivation" were used as dependant variables, and the setting and time since implementation of the CGU/CGA as independent variables. Results: Of the study population of 2572 professionals, 1395 (54%) responded (67% in primary care and 51% in hospital care). A total of 87% had been working for 5 years or more in their positions. Thirty-three percent had worked for less than a year in clinical governance. The item with the highest score was job training (8.39 ± 1.42) and that with the lowest was conflicts with peers (3.23 ± 2.2). Primary healthcare professionals showed better results in management support and quality of life at work and hospital professionals in workload. The clinical governance model obtained the best scores at 3 years and the worst at 1 year. These differences were especially favorable for clinical governance in hospitals: professionals working longer perceived a lower workload and more intrinsic motivation and quality of life. Conclusions: A longer time working in the clinical governance model was associated with better perception of professional quality of life, especially in hospital care (AU)

Tuberculosis genitourinaria y osteoparticulr (Mal de Pott) / Genitourinary and osteoarticular tuberculosis (Pott´s disease)

OBJETIVO: Presentamos el caso de un paciente con Tuberculosis urogenital y osteoarticular.MÉTODO: Paciente en estudio por síndrome febril sin foco infeccioso aparente en tratamiento con hemodiálisis al que se le realizan múltiples pruebas diagnósticas.RESULTADOS: Se pauta tratamiento médico antituberculoso remitiendo el cuadro.CONCLUSIÓN: El estudio urográfico precoz puede ser determinante en el diagnóstico de la tuberculosis urogenital en estadios iniciales, evitando así el deterioro progresivo de la función renal(AU)

OBJECTIVE: We present the case of a patient with urogenital and osteoarticular tuberculosis.METHODS: Patient with end stage renal disease on hemodyalisis in study for fever of unknown origin. Multiple diagnostic tests were performed.RESULTS: Medical treatment for tuberculosis was given with impro-vement of the symptoms.CONCLUSION: The early urogram study can be crucial in the diagnosis of urogenital tuberculosis in initial stages, thus avoiding the progressive deterioration of kidney function(AU)

Insuficiencia respiratoria aguda en el postoperatorio inmediato de cirugía por obesidad mórbida / Acute respiratory failure immediately following surgery for morbid obesity

Los pacientes con síndrome de apneas-hipopneas durante el sueño tienen una mayor probabilidad de presentar más complicaciones postoperatorias. La utilización precoz de tratamiento con presión positiva continua de la vía aérea puede evitar su aparición. Se presenta el caso de un paciente intervenido de obesidad mórbida que desarrolló, en el postoperatorio inmediato, un cuadro de insuficiencia respiratoria aguda, que precisó el reingreso en la unidad de reanimación y evolucionó favorablemente tras la instauración de tratamiento con presión positiva con 2 niveles de presión. Posteriormente se confirmó que presentaba síndrome de apneas-hipopneas durante el sueño (AU)

Patients with sleep apnea-hypopnea syndrome have a higher probability of presenting more postoperative complications, yet early treatment with continuous positive airway pressure can prevent them. We report the case of a patient who underwent surgery for morbid obesity and who developed acute respiratory failure in the immediate postoperative period, requiring readmission to the recovery unit. The patient's condition progressed favorably following treatment with bilevel positive airway pressure. It was subsequently confirmed that the patient suffered from sleep apnea-hypopnea syndrome (AU)

La Ley de cohesión y calidad del Sistema Nacional de Salud: nuevo intento de coordinación / The law of the cohesion and quality of the Spanish National Health System: new attempt at coordination

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