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INTRODUCTION: Limited evidence exists on the distribution of ABO RhD blood groups and prevalence and specificity of red blood cell (RBC) alloantibodies in Aboriginal and Torres Strait Islander peoples of Australia. We investigated RBC alloantibody prevalence and ABO RhD groups in Aboriginal patients undergoing cardiac surgery at a South Australian (SA) tertiary hospital, a major cardiac surgical referral centre for Northern Territory (NT) patients METHODS: Retrospective analysis of all consecutive patients undergoing cardiac surgery at Flinders Medical Centre (FMC) between January 2014 and June 2019. ABO and RhD blood groups, and RBC alloantibody prevalence, specificity, and clinical significance in Aboriginal and non-Aboriginal cardiac patients were determined at time of surgery and on follow up to 2021. RESULTS: 2327 patients were included, 588 (25.3 %) were from NT, and 420 (18.0 %) were Aboriginal. Aboriginal patients had a higher prevalence of ABO group O (59.8 % vs 43.9 %) and RhD positive (99.0 % vs 83.8 %). One-hundred-and-eleven patients had 154 RBC alloantibodies, 57/420 (13.6 %) Aboriginal versus 54/1907 (2.8 %) non-Aboriginal (p < 0.0001). There were higher numbers of IgM alloantibodies in Aboriginal patients (59/77, 76.6 %), with Lewis, P1 and M more common. Sixty patients had antibodies detected at time of surgery, 14 NT patients with previously detected alloantibodies, prior to surgery, presented with a negative antibody screen and 37 had new antibodies detected after cardiac surgery. CONCLUSION: A high prevalence of IgM alloantibodies was found in Aboriginal compared to non-Aboriginal cardiac surgery patients. The clinical significance of these IgM alloantibodies in Aboriginal peoples requires further investigation.
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Sistema del Grupo Sanguíneo ABO , Procedimientos Quirúrgicos Cardíacos , Isoanticuerpos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sistema del Grupo Sanguíneo ABO/inmunología , Australia , Procedimientos Quirúrgicos Cardíacos/métodos , Isoanticuerpos/sangre , Prevalencia , Estudios Retrospectivos , Sistema del Grupo Sanguíneo Rh-Hr/inmunología , Aborigenas Australianos e Isleños del Estrecho de TorresRESUMEN
The central thesis of this article is that by anchoring bioethics' core conceptual armamentarium in a four-principled theory emphasizing autonomy and treating justice as a principle of allocation, theorists inadvertently biased 20th-century bioethical scholarship against addressing such subjects as ableism, anti-Black racism, classism, and other forms of discrimination, placing them outside of the scope of bioethics research and scholarship. It is also claimed that these scope limitations can be traced to the displacement of the nascent concept of respect for persons-a concept designed to address classist and racist discrimination-with the morally solipsistic concept of autonomy.
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Bioética , Racismo , Humanos , Eticistas , Justicia Social , Autonomía PersonalRESUMEN
Successfully combating the COVID-19 pandemic depends on mass vaccination with suitable vaccines to achieve herd immunity. Here, we describe COVI-VAC, the only live attenuated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine currently in clinical development. COVI-VAC was developed by recoding a segment of the viral spike protein with synonymous suboptimal codon pairs (codon-pair deoptimization), thereby introducing 283 silent (point) mutations. In addition, the furin cleavage site within the spike protein was deleted from the viral genome for added safety of the vaccine strain. Except for the furin cleavage site deletion, the COVI-VAC and parental SARS-CoV-2 amino acid sequences are identical, ensuring that all viral proteins can engage with the host immune system of vaccine recipients. COVI-VAC was temperature sensitive in vitro yet grew robustly (>107 plaque forming units/mL) at the permissive temperature. Tissue viral loads were consistently lower, lung pathology milder, and weight loss reduced in Syrian golden hamsters (Mesocricetus auratus) vaccinated intranasally with COVI-VAC compared to those inoculated with wild-type (WT) virus. COVI-VAC inoculation generated spike IgG antibody levels and plaque reduction neutralization titers similar to those in hamsters inoculated with WT virus. Upon challenge with WT virus, COVI-VAC vaccination reduced lung challenge viral titers, resulted in undetectable virus in the brain, and protected hamsters from almost all SARS-CoV-2-associated weight loss. Highly attenuated COVI-VAC is protective at a single intranasal dose in a relevant in vivo model. This, coupled with its large-scale manufacturing potential, supports its potential use in mass vaccination programs.
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Vacunas contra la COVID-19/inmunología , Vacunas contra la COVID-19/farmacología , COVID-19/inmunología , COVID-19/prevención & control , SARS-CoV-2/inmunología , Animales , Anticuerpos Antivirales/inmunología , COVID-19/epidemiología , Chlorocebus aethiops , Femenino , Humanos , Masculino , Mesocricetus , Pandemias , Glicoproteína de la Espiga del Coronavirus/genética , Glicoproteína de la Espiga del Coronavirus/inmunología , Vacunación , Vacunas Atenuadas/inmunología , Células VeroRESUMEN
ABSTRACT: Brown, FSA, Fields, JB, Jagim, AR, Baker, RE, and Jones, MT. Analysis of in-season external load and sport performance in women's collegiate basketball. J Strength Cond Res 38(2): 318-324, 2024-Quantifying and monitoring athlete workload throughout a competitive season is a means to manage player readiness. Therefore, the purpose of the current study was to quantify practice and game external loads and to assess the relationship between such loads and basketball-specific performance metrics across a women's collegiate basketball season. Thirteen National Collegiate Athletic Association Division I women basketball athletes (age 20.08 ± 1.55 years) wore Global Positioning Systems sensors equipped with triaxial accelerometers for 29 games and 66 practices during the 2019-20 season. A multivariate analysis of variance was used to assess differences in external load between high- and low-minute players and across quarters within games ( p < 0.05). Bivariate Pearson correlation coefficients were run to determine relationships between external loads and metrics of basketball performance. Findings indicated that high- and low-minute athletes experienced different loads during games and practices ( p < 0.001). External loads differed by quarter, such that player load (PL) was highest in Q4 ( p = 0.007), PL·min -1 was highest in Q1 and lowest in Q4 ( p < 0.001), and explosive ratio (i.e., ratio of PL and explosive efforts) was lowest in Q3 ( p = 0.45). Relationships existed between PL·min -1 and field goals ( r = 0.41; p = 0.02) and between the explosive ratio and free throws ( r = 0.377 p = 0.04). These results can be used to inform design of training sessions with the intent to prepare athletes for the demands of the competitive season. It is recommended that future research continue to explore the relationship of sport-specific performance metrics and athlete external load.
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Baloncesto , Humanos , Femenino , Adolescente , Adulto Joven , Adulto , Estaciones del Año , Universidades , Atletas , Sistemas de Información GeográficaRESUMEN
BACKGROUND: Predictors of long-term saphenous vein graft (SVG) patency following coronary artery bypass grafting (CABG) include harvesting technique, degree of proximal coronary stenosis, and target vessel diameter and runoff. The objective of this study was to evaluate the association between vein graft diameter and long-term survival. METHODS: Patients undergoing primary CABG (2000-2017) at Flinders Medical Centre, Adelaide, Australia, were categorised into three groups according to average SVG diameter (<3.5 mm [small], 3.5-4 mm [medium], >4 mm [large]). Survival data was obtained from the Australian Institute of Health and Welfare National Death Index. To determine the association of SVG diameter with long-term survival we used Kaplan-Meier survival analysis and Cox proportional hazard models adjusted for preoperative variables associated with survival. RESULTS: Vein graft diameter was collected in 3,797 patients. Median follow-up time was 7.6 years (interquartile range, 3.9-11.8) with 1,377 deaths. SVG size >4 mm was associated with lower rates of adjusted survival up to 4 years postoperatively (hazard ratio 1.48; 95% confidence interval 1.05-2.1; p=0.026). CONCLUSIONS: Vein graft diameter >4mm was found to be associated with lower rates of survival following CABG.
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Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria , Vena Safena , Grado de Desobstrucción Vascular , Humanos , Vena Safena/trasplante , Puente de Arteria Coronaria/métodos , Masculino , Femenino , Anciano , Enfermedad de la Arteria Coronaria/cirugía , Estudios Retrospectivos , Persona de Mediana Edad , Estudios de Seguimiento , Tasa de Supervivencia/tendencias , Australia/epidemiologíaRESUMEN
Our previous study found that water activity (aw)- and matrix-dependent bacterial resistance wasdeveloped in Salmonella Typhimurium during antimicrobial-assisted heat treatment in low moisture foods (LMFs) matrices. To better understand the molecular mechanism behind the observed bacterial resistance, gene expression analysis was conducted on S. Typhimurium adapted to different conditions with or without the trans-cinnamaldehyde (CA)-assisted heat treatment via quantitative polymerase chain reaction (qPCR). Expression profiles of nine stress-related genes were analyzed. The upregulation of rpoH and dnaK and downregulation of ompC were observed during bacterial adaptation in LMF matrices and the combined heat treatment, which likely contributed to the bacterial resistance during the combined treatment. Their expression profiles were partially consistent with the previously-observed effect of aw or matrix on bacterial resistance. The upregulation of rpoE, otsB, proV, and fadA was also observed during adaptation in LMF matrices and might contribute to desiccation resistance, but likely did not contribute to bacterial resistance during the combined heat treatment. The observed upregulation of fabA and downregulation of ibpA could not be directly linked to bacterial resistance to either desiccation or the combined heat treatment. The results may assist the development of more efficient processing methods against S. Typhimurium in LMFs.
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Calor , Salmonella typhimurium , Salmonella typhimurium/genética , Acroleína/farmacología , Microbiología de AlimentosRESUMEN
Increased thermal resistance of Salmonella at low water activity (aw) is a significant food safety concern in low-moisture foods (LMFs). We evaluated whether trans-cinnamaldehyde (CA, 1000 ppm) and eugenol (EG, 1000 ppm), which can accelerate thermal inactivation of Salmonella Typhimurium in water, can show similar effect in bacteria adapted to low aw in different LMF components. Although CA and EG significantly accelerated thermal inactivation (55 °C) of S. Typhimurium in whey protein (WP), corn starch (CS) and peanut oil (PO) at 0.9 aw, such effect was not observed in bacteria adapted to lower aw (0.4). The matrix effect on bacterial thermal resistance was observed at 0.9 aw, which was ranked as WP > PO > CS. The effect of heat treatment with CA or EG on bacterial metabolic activity was also partially dependent on the food matrix. Bacteria adapted to lower aw had lower membrane fluidity and unsaturated to saturated fatty acids ratio, suggesting that bacteria at low aw can change its membrane composition to increase its rigidity, thus increasing resistance against the combined treatments. This study demonstrates the effect of aw and food components on the antimicrobials-assisted heat treatment in LMF and provides an insight into the resistance mechanism.
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Eugenol , Salmonella typhimurium , Calor , Microbiología de Alimentos , Agua/análisis , Recuento de Colonia MicrobianaRESUMEN
[This corrects the article DOI: 10.1371/journal.pgen.1008367.].
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The landmark 2016 Minimal Invasive Extracorporeal Technologies International Society (MiECTiS) position paper promoted the creation of a common language between cardiac surgeons, anesthesiologists and perfusionists which led to the development of a stable framework that paved the way for the advancement of minimal invasive perfusion and related technologies. The current expert consensus document offers an update in areas for which new evidence has emerged. In the light of published literature, modular minimal invasive extracorporeal circulation (MiECC) has been established as a safe and effective perfusion technique that increases biocompatibility and ultimately ensures perfusion safety in all adult cardiac surgical procedures, including re-operations, aortic arch and emergency surgery. Moreover, it was recognized that incorporation of MiECC strategies advances minimal invasive cardiac surgery (MICS) by combining reduced surgical trauma with minimal physiologic derangements. Minimal Invasive Extracorporeal Technologies International Society considers MiECC as a physiologically-based multidisciplinary strategy for performing cardiac surgery that is associated with significant evidence-based clinical benefit that has accrued over the years. Widespread adoption of this technology is thus strongly advocated to obtain additional healthcare benefit while advancing patient care.
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Procedimientos Quirúrgicos Cardíacos , Adulto , Humanos , Procedimientos Quirúrgicos Cardíacos/métodos , Circulación Extracorporea/métodos , Perfusión , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , CorazónRESUMEN
In comparison with retrotransposons, DNA transposons make up a smaller proportion of most plant genomes. However, these elements are often proximal to genes to affect gene expression depending on the activity of the transposons, which is largely reflected by the activity of the transposase genes. Here, we show that three AT-rich introns were retained in the TNP2-like transposase genes of the Bot1 (Brassica oleracea transposon 1) CACTA transposable elements in Brassica oleracea, but were lost in the majority of the Bot1 elements in Brassica rapa. A recent burst of transposition of Bot1 was observed in B. oleracea, but not in B. rapa. This burst of transposition is likely related to the activity of the TNP2-like transposase genes as the expression values of the transposase genes were higher in B. oleracea than in B. rapa. In addition, distinct populations of small RNAs (21, 22 and 24 nt) were detected from the Bot1 elements in B. oleracea, but the vast majority of the small RNAs from the Bot1 elements in B. rapa are 24 nt in length. We hypothesize that the different activity of the TNP2-like transposase genes is likely associated with the three introns, and intron loss is likely reverse transcriptase mediated. Furthermore, we propose that the Bot1 family is currently undergoing silencing in B. oleracea, but has already been silenced in B. rapa. Taken together, our data provide new insights into the differentiation of transposons and their role in the asymmetric evolution of these two closely related Brassica species.
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Brassica/genética , Elementos Transponibles de ADN/genética , Evolución Molecular , Genes de Plantas/genética , Genoma de Planta/genética , Intrones/genética , Interferencia de ARN , ARN de Planta/genética , Brassica rapa/genéticaRESUMEN
Plant developmental dynamics can be heritable, genetically correlated with fitness and yield, and undergo selection. Therefore, characterizing the mechanistic connections between the genetic architecture governing plant development and the resulting ontogenetic dynamics of plants in field settings is critically important for agricultural production and evolutionary ecology. We use hierarchical Bayesian Function-Valued Trait (FVT) models to estimate Brassica rapa growth curves throughout ontogeny, across two treatments, and in two growing seasons. We find genetic variation for plasticity of growth rates and final sizes, but not the inflection point (transition from accelerating to decelerating growth) of growth curves. There are trade-offs between growth rate and duration, indicating that selection for maximum yields at early harvest dates may come at the expense of late harvest yields and vice versa. We generate eigengene modules and determine which are co-expressed with FVT traits using a Weighted Gene Co-expression Analysis. Independently, we seed a Mutual Rank co-expression network model with FVT traits to identify specific genes and gene networks related to FVT. GO-analyses of eigengene modules indicate roles for actin/cytoskeletal genes, herbivore resistance/wounding responses, and cell division, while MR networks demonstrate a close association between metabolic regulation and plant growth. We determine that combining FVT Quantitative Trait Loci (QTL) and MR genes/WGCNA eigengene expression profiles better characterizes phenotypic variation than any single data type (i.e. QTL, gene, or eigengene alone). Our network analysis allows us to employ a targeted eQTL analysis, which we use to identify regulatory hotspots for FVT. We examine cis vs. trans eQTL that mechanistically link FVT QTL with structural trait variation. Colocalization of FVT, gene, and eigengene eQTL provide strong evidence for candidate genes influencing plant height. The study is the first to explore eQTL for FVT, and specifically do so in agroecologically relevant field settings.
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Brassica rapa/genética , Brassica rapa/metabolismo , Regulación de la Expresión Génica de las Plantas/genética , Teorema de Bayes , Perfilación de la Expresión Génica/métodos , Regulación de la Expresión Génica de las Plantas/fisiología , Redes Reguladoras de Genes/genética , Genómica/métodos , Genotipo , Fenotipo , Sitios de Carácter Cuantitativo/genética , Transcriptoma/genéticaRESUMEN
Currently 30-day mortality is commonly used as a quality indicator for cardiac surgery; however, prediction models have not included the role of cardiopulmonary bypass (CPB). We hypothesized that reproducing currently utilised prediction model methods of 30-day mortality using the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR) would identify relevant CPB predictors. Nine centers in Australia and New Zealand collected data using the ANZCPR between 2011-2020. CPB parameter selection was determined by evaluating association with 30-day mortality. Data were divided into model creation (n = 15,073) and validation sets (n = 15,072). Bootstrap sampling and automated variable selection methods were used to develop candidate models. The final model was selected using prediction mean square error and Bayesian Information Criteria. The average receiver operating characteristic (ROC), p-value for Hosmer-Lemeshow chi-squared test and MSE were obtained from multifold validation. In total, 30,145 patients were included, of which 735 (2.4%) died within 30 day of surgery. The area under the ROC curve for the model including CPB parameters was significantly greater than preoperative risk factors only (0.829 vs 0.783, p < 0.001). CPB parameters included in the predictive model were CPB time, red blood cell transfusion, mean arterial pressure <50 mmHg, minimum oxygen delivery, cardiac index <1.6 L/min/m2. CPB parameters improve the prediction of 30-day mortality. Randomised trials designed to evaluate modifiable CPB parameters will determine their impact on mortality.
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OBJECTIVE: Frailty is common in the aortic stenosis (AS) population and impacts outcomes after both transcatheter and surgical aortic valve replacement (TAVR and sAVR, respectively). Frailty can significantly impact the decision regarding the suitability of a patient for aortic valve intervention, with frail patients often excluded. Since many frailty tools use indicators which may be influenced by AS itself, some of which are subjectively symptom driven, we sought to determine the impact of intervention on frailty scores. METHODS: A prospective, observational cohort study included patients being assessed for aortic valve (AV) intervention with either TAVR or sAVR due to severe aortic stenosis. Patients were assessed for symptoms at baseline, and 1- and 6-months post intervention subjectively, using the New York Heart Association (NYHA) class and the Kansas City Cardiomyopathy Questionnaire (KCCQ), and objectively, using a 6-minute walk test (6MWT). These were compared with frailty at baseline and final review using the Fried Frailty Scale (FFS). RESULTS AND CONCLUSIONS: Sixty-six (66) patients completed pre- and post-intervention reviews. The mean FFS score was significantly lower, indicating less frailty, at 6 months relative to pre procedure (1.18 vs 1.73, p=0.002). This correlated with the change in symptoms (p<0.001). Between intervention groups, the final mean FFS of both groups decreased significantly, with TAVR to 1.33 (p=0.030) and sAVR to 0.8 (p=0.015). There was no difference in the degree of improvement between interventions (p=0.517). Aortic valve intervention improves frailty scores in both TAVR and sAVR treated patients.
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Estenosis de la Válvula Aórtica , Fragilidad , Implantación de Prótesis de Válvulas Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/cirugía , Fragilidad/diagnóstico , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Estudios Prospectivos , Factores de Riesgo , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Resultado del TratamientoRESUMEN
Tom Beauchamp and James Childress's revolutionary textbook, Principles of Biomedical Ethics, shaped the field of bioethics in America and around the world. Midway through the Principle's eight editions, however, the authors jettisoned their attempt to justify the four principles of bioethics -autonomy, beneficence, nonmaleficence, justice-in terms of ethical theory, replacing it with the idea that these principles are part of a common morality shared by all rational persons committed to morality, at all times, and in all places. Other commentators contend that their theory has never been empirically confirmed and is unfalsifiable, since counterexamples can be deemed irrational, or as held by those living lives not committed to morality. The thesis of this paper is that common morality theory is the artifact of a category mistake-conflating common areas regulated by moral norms with common norms regulating moral conduct-that accords mid-twentieth century American liberal morality the status of transcultural, transtemporal, eternal moral truths. Such a conception offers bioethicists no tools for analyzing moral change-moral progress, regress, reform, evolution, devolution, or revolution-no theoretical basis for deconstructing structural classicism, racism, and sexism, or for facilitating international cooperation on ethical issues in the context of culturally based moral differences.
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Bioética , Teoría Ética , Beneficencia , Humanos , Principios Morales , Ética Basada en Principios , Justicia SocialRESUMEN
CONTEXT: Iliotibial band syndrome (ITBS) is a common overuse injury in runners with parallels to our findings of overuse in Greco Roman wrestlers. Despite research indicating coordination and movement-based factors about the hip, no studies were found using functional motor control (FMC) in runners or wrestlers with ITBS. Thus, we compared FMC exercises and therapeutic exercises (TEs) on pain, function, muscle strength, and range of motion (ROM) in national-level Greco Roman wrestlers with ITBS. DESIGN: Controlled laboratory study. METHODS: Sixty national-level Greco Roman wrestlers diagnosed with ITBS were randomly assigned to 8 weeks of FMC exercises, TE, and a control group (20 individuals for each group). Pain (visual analog scale), function (triple hop test for distance, single-leg vertical jump test, and agility T test), muscle strength (handheld dynamometer), and ROM (goniometer) were measured at baseline and 8 weeks after intervention as posttest. RESULTS: Although both interventions significantly reduced pain (P < .001, η2 = .87), improved function (triple hop test P = .004, η2 = .94; single-leg vertical jump P = .002, η2 = .93; and T test P < .001, η2 = .93) and strength (hip abduction (P < .001, η2 = .52), hip external rotation (P = .02, η2 = .95), knee flexion (P ≤ .001, η2 = .94), and knee extension (P < .001, η2 = .91) compared with the control group, FMC showed more significant improvements in comparison with TE. Significant differences (P = .001) were observed between FMC and TE compared with the control group in ROM outcome. However, TE was more effective than FMC in improving ROM hip abduction (P < .001, η2 = .93), hip adduction (P = .000, η2 = .92), hip internal rotation (P < .001, η2 = .92), and hip external rotation (P < .001, η2 = .93). CONCLUSION: FMC exercises were superior to TE in terms of pain, function, and muscle strength, whereas TE was more effective for improving ROM. FMC exercise is suggested as an effective intervention for improvement of the outcomes related to ITBS in national-level Greco Roman wrestlers.
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Síndrome de la Banda Iliotibial , Humanos , Fenómenos Biomecánicos , Síndrome de la Banda Iliotibial/terapia , Articulación de la Rodilla , Fuerza Muscular/fisiología , Dolor , Rango del Movimiento Articular/fisiologíaRESUMEN
Background Approximately 20% to 30% of patients awaiting cardiac surgery are anemic. Anemia increases the likelihood of requiring a red cell transfusion and is associated with increased complications, intensive care, and hospital stay following surgery. Iron deficiency is the commonest cause of anemia and preoperative intravenous (IV) iron therapy thus may improve anemia and therefore patient outcome following cardiac surgery. We have initiated the intravenous iron for treatment of anemia before cardiac surgery (ITACS) Trial to test the hypothesis that in patients with anemia awaiting elective cardiac surgery, IV iron will reduce complications, and facilitate recovery after surgery. Methods ITACS is a 1,000 patient, international randomized trial in patients with anemia undergoing elective cardiac surgery. The patients, health care providers, data collectors, and statistician are blinded to whether patients receive IV iron 1,000 mg, or placebo, at 1-26 weeks before their planned date of surgery. The primary endpoint is the number of days alive and at home up to 90 days after surgery. Results To date, ITACS has enrolled 615 patients in 30 hospitals in 9 countries. Patient mean (SD) age is 66 (12) years, 63% are male, with a mean (SD) hemoglobin at baseline of 118 (12) g/L; 40% have evidence (ferritin <100 ng/mL and/or transferrin saturation <25%) suggestive of iron deficiency. Most (59%) patients have undergone coronary artery surgery with or without valve surgery. Conclusions The ITACS Trial will be the largest study yet conducted to ascertain the benefits and risks of IV iron administration in anemic patients awaiting cardiac surgery.
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Anemia Ferropénica , Procedimientos Quirúrgicos Cardíacos , Cardiopatías , Hierro , Cuidados Preoperatorios/métodos , Administración Intravenosa , Anciano , Anemia Ferropénica/complicaciones , Anemia Ferropénica/diagnóstico , Anemia Ferropénica/tratamiento farmacológico , Anemia Ferropénica/fisiopatología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/clasificación , Procedimientos Quirúrgicos Cardíacos/métodos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Método Doble Ciego , Procedimientos Quirúrgicos Electivos/efectos adversos , Procedimientos Quirúrgicos Electivos/métodos , Procedimientos Quirúrgicos Electivos/mortalidad , Femenino , Cardiopatías/sangre , Cardiopatías/complicaciones , Cardiopatías/cirugía , Fármacos Hematológicos/administración & dosificación , Fármacos Hematológicos/efectos adversos , Hemoglobinas/análisis , Humanos , Hierro/administración & dosificación , Hierro/efectos adversos , Masculino , Evaluación de Resultado en la Atención de Salud , Proyectos de Investigación , Medición de RiesgoRESUMEN
INTRODUCTION: High-sensitivity troponin T (hs-TnT), as a single or serial measurement to predict postoperative mortality and morbidity, appears to be attractive due to its direct relationship in assessing myocardial damage and the widespread availability of hs-TnT testing. Therefore, this study aimed to identify any prognostic value of hs-TnT in predicting in-hospital outcomes after coronary artery bypass graft (CABG) surgery. METHOD: We identified all consecutive patients who underwent on-pump CABG between July 2011 and December 2018. To evaluate the prognostic value of hs-TnT after CABG, we assessed the probability and odds ratio (OR) of adverse events concerning the maximum value of postoperative hs-TnT (measured within 24 hrs). TnT was routinely collected at 0, 6, 12 and 72 hours postoperatively. Values were categorised into intervals of 200 for analysis. A fully Bayesian logistic regression of the adverse event with the troponin T interval (0-200) as the reference level was used. A subgroup analysis was performed in patients with normal and elevated preoperative hs-TnT (< or ≥30 ng/L). The pre-specified primary outcome was a major adverse cardiac or cerebrovascular event (MACCE), defined as a composite of death within 30 days of operation for any cause, myocardial infection (MI), or stroke. RESULTS: 1,318 people underwent on-pump CABG during this period. One hundred and twenty-three (123) (9.3%) experienced MACCE, 14 (1.1%) experienced death within 30 days, 105 (8.0%) experienced MI and 14 (1.1%) experienced stroke. Compared to the reference category (hs-TnT ≤200 ng/L) we found there was an increase in OR with increasing level of hs-TnT for MACCE (p<0.001), 30-day mortality (p=0.003), MI (p<0.001) and ICU stay >48 hours (p<0.001). However, there was no statistically significant association present between hs-TnT and stroke, readmission to the intensive care unit (ICU), return to theatre for bleeding, or new-onset renal dysfunction. CONCLUSION: Peak hs-TnT level, greater than 400 ng/L, measured within 24 hours after CABG surgery is associated with MACCE, 30-day mortality, MI and ICU stay >48 hours. Prospectively designed trials, with clear prognostic and outcome variables, may provide further insight into the prognostic value of hs-TnT post-CABG.
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Puente de Arteria Coronaria , Troponina T , Teorema de Bayes , Biomarcadores , Humanos , PronósticoRESUMEN
The current gold standard for diagnosis of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) is through a liver biopsy, and there is an urgent need to develop non-invasive methods for early detection. We previously demonstrated metabolic remodeling in the mouse fatty liver, which is marked by increased hepatic expression and activities of phosphoglucose isomerase (PGI) and several other glycolytic enzymes. Since PGI is actively transported out of the cell, acting as a multifunctional cytokine referred to as autocrine motility factor (AMF), we explored the possibility that PGI secreted from the fatty liver may be targeted for early detection of the silent disease. We report here that mice with NASH exhibited significantly elevated serum PGI enzyme activities compared to normal control (P < 0.005). We further confirmed the finding using serum/plasma samples (n = 73) collected from a cohort of NASH patients who were diagnosed according to Kleiner's criteria, showing a normal mean PGI of 19.5 ± 8.8 IU/L and patient mean PGI of 105.6 ± 79.9 IU/L (P < 0.005). In addition, elevated blood PGI in NASH patients coincided with increased blood L-lactate. Cell culture experiments were then conducted to delineate the PGI-lactate axis, which revealed that treatment of HepG2 cells with recombinant PGI protein stimulated glycolysis and lactate output, suggesting that the disease-induced PGI likely contributed to the increased lactate in NASH patients. Taken together, the preclinical and clinical data validate secreted PGI as a useful biomarker of the fatty liver that can be easily screened at the point of care.
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Glucosa-6-Fosfato Isomerasa/metabolismo , Enfermedad del Hígado Graso no Alcohólico/enzimología , Adolescente , Animales , Biomarcadores/metabolismo , Niño , Preescolar , Glucosa-6-Fosfato Isomerasa/sangre , Células Hep G2 , Humanos , Ácido Láctico/metabolismo , Modelos Lineales , Ratones Endogámicos C57BL , Enfermedad del Hígado Graso no Alcohólico/sangreRESUMEN
ID15A is a newly refurbished beamline at the ESRF devoted to operando and time-resolved diffraction and imaging, total scattering and diffraction computed tomography. The beamline is optimized for rapid alternation between the different techniques during a single operando experiment in order to collect complementary data on working systems. The high available energy (up to 120â keV) means that even bulky and highly absorbing systems may be studied. The beamline is equipped with optimized focusing optics and a photon-counting CdTe pixel detector, allowing for both unprecedented data quality at high energy and for very rapid triggered experiments. A large choice of imaging detectors and ancillary probes and sample environments is also available.
RESUMEN
Neptunium(V) and uranium(VI) are precipitated from an aqueous potassium-sodium-containing carbonate-rich solution, and the solid phases are investigated. U/Np M4,5-edge high-energy resolution X-ray absorption near edge structure (HR-XANES) spectroscopy and Np 3d4f resonant inelastic X-ray scattering (3d4f RIXS) are applied in combination with thermodynamic calculations, U/Np L3-edge XANES, and extended X-ray absorption fine structure (EXAFS) studies to analyze the local atomic coordination and oxidation states of uranium and neptunium. The XANES/HR-XANES analyses are supported by ab initio quantum-chemical computations with the finite difference method near-edge structure code (FDMNES). The solid precipitates are also investigated with powder X-ray diffraction, scanning electron microscopy-energy dispersive X-ray spectroscopy, and Raman spectroscopy. The results strongly suggest that K[NpVO2CO3](cr), K3[NpVO2(CO3)2](cr), and K3Na[UVIO2(CO3)3](cr) are the predominant neptunium and uranium solid phases formed. Despite the 100 times lower initial neptunium(V) concentration at pH 10.5 and oxic conditions, neptunium(V)-rich phases predominately precipitate. The prevailing formation of neptunium(V) over uranium(VI) solids demonstrates the high structural stability of neptunium(V) carbonates containing potassium. It is illustrated that the Np M5-edge HR-XANES spectra are sensitive to changes of the Np-O axial bond length for neptunyl(V/VI).