Progressive multifocal leukoencephalopathy, advanced ductal breast carcinoma, systemic sclerosis, and checkpoint inhibitors: a therapeutic dilemma.

Progressive multifocal leukoencephalopathy (PML) is a demyelinating central nervous system disease infection by JC virus (JCV) in patients with a significant decline in cellular immunity. No specific treatment has demonstrated efficacy, and the disease progresses to death in most patients. Recent findings have shown stabilization or improvement of PML lesions after treatment with checkpoint inhibitors (CPI) based on immune reconstitution. Nevertheless, immunotherapy may specifically cause autoimmune diseases or may deteriorate pre-existing ones. We report a case of a patient under treatment for advanced ductal breast carcinoma and systemic sclerosis, who developed PML. The therapeutic approach included withdrawal of drugs with possible immunosuppressive effect and treatment with pembrolizumab. In the absence of reliable markers to predict CPIs response and a concern for an autoimmune worsening, immunotherapy was administered late in the course of the disease. Finally, she did not experience an autoimmune disease flare-up; however, pembrolizumab could not prevent disease progression. We believe that potential autoimmune complications should not delay treatment initiation with CPIs in PML.

A world together: Global citizen identification as a basis for prosociality in the face of COVID-19.

How do global citizens respond to a global health emergency? The present research examined the association between global citizen identification and prosociality using two cross-national datasets-the World Values Survey (Study 1, N = 93,338 from 60 countries and regions) and data collected in 11 countries at the start of the COVID-19 pandemic (Study 2, N = 5,427). Results showed that individuals who identified more strongly as global citizens reported greater prosociality both generally (Study 1) and more specifically in the COVID-19 global health emergency (Study 2). Notably, global citizen identification was a stronger predictor of prosociality in response to COVID-19 than national identification (Study 2). Moreover, analyses revealed that shared ingroup identity accounted for the positive association between global citizen identification and prosociality (Study 2). Overall, these findings highlight global citizenship as a unique and promising direction in promoting prosociality and solidarity, especially in the fight against COVID-19.

Predictive Model and Risk Score for In-Hospital Mortality in Patients with All-Cause Cardiogenic Shock.

Cardiogenic shock (CS) is a condition associated with high morbidity and mortality. Our study aimed to perform a risk score for in-hospital mortality that allows for stratifying the risk of death in patients with CS.This is a retrospective analysis, which included 135 patients from a Spanish university hospital between 2011 and 2020. The Santiago Shock Score (S3) was created using clinical, analytical, and echocardiographic variables obtained at the time of admission.The in-hospital mortality rate was 41.5%, and acute coronary syndrome (ACS) was the responsible cause of shock in 60.7% of patients. Mitral regurgitation grade III-IV, age, ACS etiology, NT-proBNP, blood hemoglobin, and lactate at admission were included in the score. The S3 had good accuracy for predicting in-hospital mortality area under the receiver operating characteristic curve (AUC) 0.85 (95% confidence interval (CI) 0.78-0.90), higher than the AUC of the CardShock score, which was 0.74 (95% CI 0.66-0.83). Predictive power in a cohort of 131 patients with profound CS was similar to that of CardShock with an AUC of 0.601 (95% CI 0.496-0.706) versus an AUC of 0.558 (95% CI 0.453-0.664). Three risk categories were created according to the S3: low (scores 0-6), intermediate (scores 7-10), and high (scores 11-16) risks, with an observed mortality of 12.9%, 49.1%, and 87.5% respectively (P < 0.001).The S3 score had excellent predictive power for in-hospital mortality in patients with nonprofound CS. It could aid the initial risk stratification of patients and thus, guide treatment and clinical decision making in patients with CS.

Long term prognostic benefit of complete revascularization in elderly presenting with NSTEMI: real world evidence.

The benefit of complete revascularization in elderly patients with non-ST elevation myocardial infarction (NSTEMI), and multivessel disease remains debated (MVD). The aim of our study was to determine the current long-term prognostic benefit of complete revascularization in this population. A retrospective cohort study of 1722 consecutive elderly NSTEMI patients was performed. Among the study participants 30.4% (n = 524) were completed revascularizated and in 69.6% (n = 1198) culprit vessel only revascularization was performed. A propensity score analysis was performed and we divided the study population into two groups: complete revascularization (n = 500) and culprit vessel only revascularization (n = 500). The median follow-up was 45.7 months, the all cause mortality (44.5% vs 30.5%, p < 0.001) (HR 0.74 (0.57-0.97); p = 0.035) and cardiovascular mortality (32.6% vs 17.4%, p < 0.001) (HR = 0.67 (0.47-0.94); p = 0.021) were significantly lower in patients with complete revascularization. In our study, we observed a long-term benefit of complete revascularization in elderly NSTEMI and MVD patients. Elderly patients should also be managed according to current guidelines to improve their long-term prognosis.

Multicenter and all-comers validation of a score to select patients for manual thrombectomy, the DDTA score.

BACKGROUND: Routine manual thrombectomy (MT) is not recommended in primary percutaneous coronary intervention (P-PCI) but it is performed in many procedures. The objective of our study was validating the DDTA score, designed for selecting patients who benefit most from MT. METHODS: Observational and multicenter study of all consecutive patients undergoing P-PCI in five institutions. Results were compared with the design cohort and the performance of the DDTA was analyzed in all patients. Primary end-point of the analyses was TIMI 3 after MT; secondary endpoints were final TIMI 3, no-reflow incidence, in-hospital mortality and in-hospital major cardiovascular events (MACE). In-hospital prognosis was assessed by the Zwolle risk score. RESULTS: Three hundred forty patients were included in the validation cohort and no differences were observed as compared to the design cohort (618 patients) except for lower use of MT and higher IIb/IIIa inhibitors or drug-eluting stents. The probability of TIMI 3 after MT decreased as delay to P-PCI was higher. If DDTA score, MT was associated to TIMI 3 after MT (OR: 4.11) and final TIMI 3 (OR: 2.44). There was a linear and continuous relationship between DDTA score and all endpoints. DDTA score ≥ 4 was independently associated to lower no-reflow, in-hospital MACE or mortality. The lowest incidence of in-hospital mortality or MACE was in patients who had DDTA score ≥ 4 and Zwolle risk score 0-3. CONCLUSIONS: MT is associated to higher rate of final TIMI3 in patients with the DDTA score ≥ 4. Patients with DDTA score ≥ 4 had lower no-reflow and in-hospital complications.

Short-course antibiotic regimen compared to conventional antibiotic treatment for gram-positive cocci infective endocarditis: randomized clinical trial (SATIE).

BACKGROUND: Most serious complications of infective endocarditis (IE) appear in the so-called "critical phase" of the disease, which represents the first days after diagnosis. The majority of patients overcoming the acute phase has a favorable outcome, yet they remain hospitalized for a long period of time mainly to complete antibiotic therapy. The major hypothesis of this trial is that in patients with clinically stable IE and adequate response to antibiotic treatment, without signs of persistent infection, periannular complications or metastatic foci, a shorter antibiotic time period would be as efficient and safe as the classic 4 to 6 weeks antibiotic regimen. METHODS: Multicenter, prospective, randomized, controlled open-label, phase IV clinical trial with a non-inferiority design to evaluate the efficacy of a short course (2 weeks) of parenteral antibiotic therapy compared with conventional antibiotic therapy (4-6 weeks). SAMPLE: patients with IE caused by gram-positive cocci, having received at least 10 days of conventional antibiotic treatment, and at least 7 days after surgery when indicated, without clinical, analytical, microbiological or echocardiographic signs of persistent infection. Estimated sample size: 298 patients. INTERVENTION: Control group: standard duration antibiotic therapy, (4 to 6 weeks) according to ESC guidelines recommendations. Experimental group: short-course antibiotic therapy for 2 weeks. The incidence of the primary composite endpoint of all-cause mortality, unplanned cardiac surgery, symptomatic embolisms and relapses within 6 months after the inclusion in the study will be prospectively registered and compared. CONCLUSIONS: SATIE will investigate whether a two weeks short-course of intravenous antibiotics in patients with IE caused by gram-positive cocci, without signs of persistent infection, is not inferior in safety and efficacy to conventional antibiotic treatment (4-6 weeks). TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04222257 (January 7, 2020). EudraCT 2019-003358-10.

Don't forget the group! The importance of social norms and empathy for shaping donation behaviour.

Feelings of empathy and the influence of social descriptive norms are related to intentions to donate. People are more likely to help and donate to others when they empathise with them, and when they perceive descriptive norms to encourage such behaviour. However, previous work has not considered the potential interplay between empathy and descriptive norms. Across two surveys in two different national settings (Ns = 1300 and 144), we assessed the interplay between empathy and social descriptive norms on frequency of donation (Study 1) and on willingness to donate (Study 2). Consistent with our main hypotheses, in Studies 1 and 2, norms and empathy were positive predictors of frequency of donation and willingness to donate. Importantly, a consistent interaction between norms and empathy was found in both studies. Empathy was a stronger predictor of donation behaviour and disposition when norms were low. Theoretical and applied implications of these findings are discussed.

Phosphinidene-Bridged MoMn Derivatives of the Thiophosphinidene Complex [Mo2Cp2(µ-κ2:κ1,η6-SPMes*)(CO)2] (Mes* = 2,4,6-C6H2tBu3).

The title complex (1) reacted with [Mn2(CO)10] under visible-UV irradiation (toluene solution and quartz glassware) to give a mixture of the phosphinidene complex [MnMoCp(µ-κ1:κ1,η6-PMes*)(CO)4], the cluster [Mn2Mo2Cp2(µ-κ1:κ1,η6-PMes*)(µ3-S)(CO)8], and the thiophosphinidene complex [MnMoCp(µ-κ2:κ1,η4-SPMes*)(CO)5], in yields of ca. 60, 20, and 10% respectively (Mes* = 2,4,6-C6H2tBu3). The major product follows from formal replacement of the SMoCp(CO)2 fragment in 1 with a Mn(CO)4 fragment, and displayed multiple bonding to phosphorus (Mn-P = 2.1414(8) Å); the tetranuclear cluster results from formal insertion of a Mn2(CO)6 fragment in 1, with cleavage of P-S and P-Mo bonds, to render a µ3-S bridged Mn2Mo core bearing an exocyclic phosphinidene ligand involved in multiple bonding to one of the Mn atoms (Mn-P = 2.140(2) Å); the thiophosphinidene complex (Mn-P = 2.294(1) Å) formally results from addition of sulfur and carbon monoxide to the major MnMo product, a transformation which actually could be performed stepwise, via the MnMo thiophosphinidene complex [MnMoCp(µ-κ2:κ1,η6-SPMes*)(CO)4]. When the photolysis of 1 and [Mn2(CO)10] was performed in tetrahydrofuran solution and using conventional glassware, then the V-shaped cluster [Mn2MoCp{µ-κ1:κ1:κ1,η5-P(C6H3tBu3)}(CO)8] was obtained selectively (Mo-Mn = 3.2910(5) Å, Mn-Mn = 2.9223(5) Å), which unexpectedly displays a cyclohexadienylidene-phosphinidene ligand resulting from H atom abstraction at the aryl ring of the precursor. Density functional theory calculations on the complexes [LnM(µ-κ1:κ1,η6-PMes*)MoCp] (MLn = MoCp(CO)2, Mn(CO)4, Co(CO)3) revealed that the degree of delocalization of the metal-phosphorus π-bonding interaction over the Mo-P-M chain is significantly conditioned by the heterometal fragment MLn, it being increased in the order Mn ≤ Mo < Co.

Prognostic value of nutrition status in the response of cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is indicated in symptomatic heart failure (HF) patients after achieving optimal medical therapy. However, there are still a large percentage of patients who do not respond to CRT. Malnutrition is a frequent comorbidity in patients with HF, and it is associated with a poorer prognosis. Here, we evaluate the nutritional status of patients assessed by Controlling Nutritional Status (CONUT) score and its association with structural remodeling and cardiovascular events. METHODS: We investigated the effect of CONUT on HF/death in 302 consecutive patients with a CRT device implanted between 2005 and 2015 in a single tertiary center. We categorized the patients into three groups: normal nutritional status (CONUT 0-1), mild malnutrition (CONUT 2-4) and moderate-severe malnutrition (CONUT ≥ 5). Changes in nutritional status were assessed in patients with mild-to-severe malnutrition prior to CRT. RESULTS: One hundred and forty-eight patients exhibited normal nutritional status (49.0%), 99 patients exhibited mild malnutrition (32.8%) and 55 patients exhibited moderate-severe malnutrition (18.2%). CONUT scores of at least 2 were associated with higher risk of HF/death compared with CONUT 0-1. Significant left ventricular (LV) reverse remodeling was noted in patients with better nutritional status. In addition, those malnutrition patients at baseline that improved nutritional state exhibited fewer HF/death events at follow-up. CONCLUSION: CONUT score prior to CRT was an independent risk factor of death/HF and was correlated with LV reverse remodeling. Improvements in CONUT score during long-term follow-up were associated with a reduction in the rate of HF/death.

C-C and C-N Couplings Following Hydride Addition on Isocyanide Cyclopolyenyl Dimolybdenum Complexes to Give Tethered Aldimine and Aminocarbene Derivatives.

Reaction of [Mo2 Cp2 (µ-κ1 :κ1 ,η6 -PMes*)(CO)2 ] with S or Se followed by protonation with [H(OEt2 )2 ](BAr'4 ) gave the cationic derivatives [Mo2 Cp2 {µ-κ2P,E :κ1P ,η5 -EP(C6 H3 tBu3 )}(CNR)(CO)2 ](BAr'4 ) (E=S; R=tBu, iPr, Ph, 4-C6 H4 OMe, Xyl; or E=Se; R=tBu; Ar'=3,5-C6 H3 (CF3 )2 ). Reaction of the latter with K[BHsBu3 ] yielded the aldimine complexes [Mo2 Cp2 {µ-κ2P,E :κ2P,N ,η4 -SP(C6 H3 tBu3 (CHNR))}(CO)2 ] and their aminocarbene isomers [Mo2 Cp2 {µ-κ2P,E :κ2P,C ,η4 -SP(C6 H3 tBu3 (NRCH))}(CO)2 ] (R ≠ Xyl), following C-C and C-N couplings, respectively. Monitoring of these reactions revealed that the initial H- attack takes place at a Cp ligand to give cyclopentadiene intermediates [Mo2 Cp{µ-κ2P,S :κ1P ,η5 -SP(C6 H3 tBu3 )}(η4 -C5 H6 )(CNR)(CO)2 ], which then undergo C-H oxidative addition to give the hydride isomers [Mo2 Cp2 {µ-κ2P,S :κ1P ,η3 -SP(C6 H3 tBu3 )}(H)(CNR)(CO)2 ]. In turn, the latter rearrange to give the aldimine and aminocarbene complexes. DFT calculations revealed that the hydride intermediates first undergo migratory insertion of the isocyanide ligand into the Mo-H bond to give unobservable formimidoyl intermediates, which then evolve either by nucleophilic attack of the N atom on the C6 ring (C-N coupling) or by migratory insertion of the formimidoyl ligand into the C6 ring (C-C coupling). Our data suggest that increasing the size of the substituent R at the isocyanide ligand destabilizes the aldimine isomer to a greater extent, thus favoring formation of the aminocarbene complex.

Gold(I) and related heterometallic derivatives of dimolybdenum complexes with asymmetric phosphinidene bridges.

The phosphinidene-bridged complexes [Mo2Cp2(µ-κ(1):κ(1),η(6)-PR*)(CO)2] (1), [Mo2Cp2(µ-κ(1):κ(1),η(4)-PR*)(CO)3] (2), [Mo2Cp(µ-κ(1):κ(1),η(5)-PC5H4)(η(6)-HR*)(CO)2] (3), and [Mo2Cp2(µ-κ(1):κ(1)-PH)(η(6)-HR*)(CO)2] (4) were examined as precursors of heterometallic gold(I) and related derivatives (Cp = η(5)-C5H5, R* = 2,4,6-C6H2(t)Bu3). These complexes reacted with [AuCl(THT)] to give the corresponding derivatives [AuMo2ClCp2(µ-κ(1):κ(1):κ(1),η(6)-PR*)(CO)2], [AuMo2ClCp2(µ-κ(1):κ(1):κ(1),η(4)-PR*)(CO)3] (Au-Mo = 2.8493(6) Å), [AuMo2ClCp(µ-κ(1):κ(1):κ(1),η(5)-PC5H4)(CO)2(η(6)-HR*)], and [AuMo2ClCp2(µ3-PH)(CO)2(η(6)-HR*)] formally resulting from the addition of an acceptor AuCl moiety to the short Mo-P bond of the parent substrates almost perpendicular to the corresponding Mo2P plane. The chloride ligand was easily displaced upon reaction of the PC5H4-bridged gold complex with K[MoCp(CO)3] to give the tetranuclear derivative [AuMo3Cp2(µ-κ(1):κ(1):κ(1),η(5)-PC5H4)(CO)5(η(6)-HR*)] (Au-Mo = 2.711(2) and 2.807(2) Å). Compound 1 also reacted with HgI2 to give a hexanuclear complex [HgMo2Cp2(µ-I)I(µ-κ(1):κ(1),η(6)-PR*)(CO)2]2 containing dative Mo→Hg bonds (2.820(1) and 2.827(1) Å), whereas complex 3 gave the µ3-PR bridged complex [HgMo2CpI2(µ-κ(1):κ(1):κ(1),η(5)-PC5H4)(CO)2(η(6)-HR*)]. Complexes 1 to 4 also reacted easily with [AuL(THT)]PF6 (L = THT, P(p-tol)3, PMe3, P(i)Pr3) to give the corresponding cationic trinuclear derivatives [AuMo2Cp2(µ-κ(1):κ(1):κ(1),η(6)-PR*)(CO)2L](PF6) (Au-Mo = 2.8080(3) Å for L = P(p-tol)3), [AuMo2Cp2(µ-κ(1):κ(1):κ(1),η(4)-PR*)(CO)3L](PF6), and [AuMo2Cp(µ-κ(1):κ(1):κ(1),η(5)-PC5H4)(CO)2(η(6)-HR*){P(p-tol)3}](PF6). The blue, analogous PH-bridged complexes were more conveniently isolated as tetra-arylborate salts [AuMo2Cp2(µ3-PH)(CO)2(η(6)-HR*)L](BAr'4) (Au-Mo = 2.8038(6) Å for L = P(i)Pr3; Ar'= 3,5-C6H3(CF3)2]. Compounds 1, 3, and 4 reacted readily with the cation [Au(THT)2](+) (as PF6(-) or BAr'4(-) salts) in a 2:1 ratio to give respectively the corresponding pentanuclear derivatives [Au{Mo2Cp2(µ-κ(1):κ(1):κ(1),η(6)-PR*)(CO)2}2](PF6), [Au{Mo2Cp(µ-κ(1):κ(1):κ(1),η(5)-PC5H4)(CO)2(η(6)-HR*)}2](PF6) (Au-Mo = 2.7975(7) and 2.8006(7) Å), and [Au{Mo2Cp2(µ3-PH)(CO)2(η(6)-HR*)}2](BAr'4) (Au-Mo = 2.8233(8) and 2.8691(7) Å). Related silver complexes were obtained from the reaction of 3 and 4 with [AgCl(PPh3)]4 after spontaneous symmetrization, while reaction of 1 with [Cu(NCMe)4]PF6 in a 2:1 ratio yielded the analogous copper complex [Cu{Mo2Cp2(µ-κ(1):κ(1):κ(1),η(6)-PR*)(CO)2}2](PF6). All the above cationic gold complexes having (µ-κ(1):κ(1):κ(1),η(6)-PR*) ligands (but not the copper complex) rearranged into [Au{Mo2Cp(µ-κ(1):κ(1):κ(1),η(5)-PC5H4)(CO)2(η(6)-HR*)}2](PF6) in refluxing 1,2-dichloroethane solution.

First European Erwinia amylovora Lytic Bacteriophage Cocktails Effective in the Host: Characterization and Prospects for Fire Blight Biocontrol.

Fire blight, caused by the plant-pathogenic bacterium Erwinia amylovora, is a highly contagious and difficult-to-control disease due to its efficient dissemination and survival and the scarcity of effective control methods. Copper and antibiotics are the most used treatments but pose environmental and human health risks. Bacteriophages (phages) constitute an ecological, safe, and sustainable fire blight control alternative. The goal of this study was to search for specific E. amylovora phages from plant material, soil, and water samples in Mediterranean environments. A collection of phages able to specifically infect and lyse E. amylovora strains was generated from former fire blight-affected orchards in Eastern Spain. Following in vitro characterization, assays in immature fruit revealed that preventively applying some of the phages or their combinations delayed the onset of fire blight symptoms and reduced the disease's severity, suggesting their biocontrol potential in Spain and other countries. The morphological and molecular characterization of the selected E. amylovora phages classified them as members of the class Caudoviricetes (former Myoviridae family) and genus Kolesnikvirus. This study reveals Mediterranean settings as plausible sources of E. amylovora-specific bacteriophages and provides the first effective European phage cocktails in plant material for the development of sustainable fire blight management measures.

A comparative approach to evaluate the toxicity of building materials through life cycle assessment.

BACKGROUND: This paper addresses the lack of research that compares the toxicity of commonly used construction materials. The toxicity of construction materials has received less attention, despite its importance within the Life Cycle Assessment methodology. All aspects, including toxicity, need to be analysed throughout the life cycle of the material to understand its true behaviour. AIM: The purpose of this study is to propose a methodology to compare the toxicity of different construction materials and highlight the need to consider toxicity criteria in the selection of materials during the design phase. The study seeks to fill the gap in the existing literature by providing information on the comparative toxicity of the most common building materials. METHODOLOGY: The study follows Life Cycle Assessment methodology as established by the ISO 14040:2006 and ISO 14044:2006 standards. For this study, statistics were consulted to identify the most used materials in the construction sector; then, from this group of materials, those available in the Ecoinvent 3.7.1 database were selected. For comparison, these materials were categorised into material families and a functional unit was established to compare them. Finally, all materials were compared with each other, using 1 kg as the functional unit. RESULTS: When we conduct a comparative analysis of various materials and categorise them into groups, it becomes readily apparent which materials demonstrate a less favourable performance with respect to their toxic properties. This approach allows us to discern and pinpoint those materials that present a more concerning level of toxicity relative to others, facilitating informed decision-making in terms of construction material selection and design. CONCLUSIONS: By comparing all materials with each other using 1 kg as the functional unit, we can conclude that some materials have a greater impact than others, both in absolute and relative terms, for example, steel and polyurethane foam.

Classification tree obtained by artificial intelligence for the prediction of heart failure after acute coronary syndromes. / Árboles de clasificación obtenidos mediante inteligencia artificial para la predicción de insuficiencia cardiaca tras el síndrome coronario agudo.

BACKGROUND: Coronary heart disease is the leading cause of heart failure (HF), and tools are needed to identify patients with a higher probability of developing HF after an acute coronary syndrome (ACS). Artificial intelligence (AI) has proven to be useful in identifying variables related to the development of cardiovascular complications. METHODS: We included all consecutive patients discharged after ACS in two Spanish centers between 2006 and 2017. Clinical data were collected and patients were followed up for a median of 53months. Decision tree models were created by the model-based recursive partitioning algorithm. RESULTS: The cohort consisted of 7,097 patients with a median follow-up of 53months (interquartile range: 18-77). The readmission rate for HF was 13.6% (964 patients). Eight relevant variables were identified to predict HF hospitalization time: HF at index hospitalization, diabetes, atrial fibrillation, glomerular filtration rate, age, Charlson index, hemoglobin, and left ventricular ejection fraction. The decision tree model provided 15 clinical risk patterns with significantly different HF readmission rates. CONCLUSIONS: The decision tree model, obtained by AI, identified 8 leading variables capable of predicting HF and generated 15 differentiated clinical patterns with respect to the probability of being hospitalized for HF. An electronic application was created and made available for free.

Dosing of iodinated contrast volume: a new simple algorithm to stratify the risk of contrast-induced nephropathy in patients with acute coronary syndrome.

OBJECTIVES AND BACKGROUND: Previous studies on contrast-induced nephropathy (CIN) have identified contrast volume (CV) as a risk factor. The aim of our research was to define the safe dose of contrast media based on absolute CV, maximum allowable contrast dose (MACD) and estimated glomerular filtrate rate (eGFR). METHODS AND RESULTS: A total of 940 consecutive patients with acute coronary syndrome (ACS) were enrolled. Fifty-four patients developed CIN. MACD was defined as 5*body weight/serum creatinine. When using a CV higher than MACD, CIN-risk was increased 19-fold (OR 9.810-39.307, P < 0.001). For the CV/eGFR ratio, we found that for every increase of one-tenth, CIN-risk increased by 4.9% (OR 1.037-1.061, P < 0.001). The discriminative ability of CV (C statistic = 0.626 ± 0.038) was significantly lower than for the CV/MACD (C statistic = 0.782 ± 0.036, P = 0.003) and CV/eGFR (C statistics: 0.796 ± 0.033 for MDRD-4, 0.796 ± 0.034 for Cockcroft-Gault, and 0.803 ± 0.033 for CKD-EPI; P < 0.001). There were no differences in the discriminative ability to predict CIN between the three eGFR equations. The combination of CV/MACD and CV/eGFR in a single protocol increases the positive predictive value of the Mehran risk score (40.7% vs. 8.8%) with the same sensitivity (90.7% vs. 83.3%). High doses of relative CV (CV/MACD and CV/eGFR) were also significantly associated with higher in-hospital mortality, reinfarction, and heart failure. CONCLUSIONS: A sequential protocol based on CV/MACD and CV/eGFR appropriately identified those ACS patients who developed CIN, with predictive values similar to a Mehran score, reducing the false positive rate. It is also useful to predict risk of in-hospital cardiac events regardless of GRACE score.

Porcine Macrophage Markers and Populations: An Update.

Besides its importance as a livestock species, pig is increasingly being used as an animal model for biomedical research. Macrophages play critical roles in immunity to pathogens, tissue development, homeostasis and tissue repair. These cells are also primary targets for replication of viruses such as African swine fever virus, classical swine fever virus, and porcine respiratory and reproductive syndrome virus, which can cause huge economic losses to the pig industry. In this article, we review the current status of knowledge on porcine macrophages, starting by reviewing the markers available for their phenotypical characterization and following with the characteristics of the main macrophage populations described in different organs, as well as the effect of polarization conditions on their phenotype and function. We will also review available cell lines suitable for studies on the biology of porcine macrophages and their interaction with pathogens.

Screening for Novel Beneficial Environmental Bacteria for an Antagonism-Based Erwinia amylovora Biological Control.

Erwinia amylovora, the bacterial species responsible for fire blight, causes major economic losses in pome fruit crops worldwide. Chemical control is not always effective and poses a serious threat to the environment and human health. Social demands for eco-sustainable and safe control methods make it necessary to search for new biocontrol strategies such as those based on antagonists. A bacterial collection from different fire blight-free Mediterranean environments was tested for antagonistic activity against Spanish strains of E. amylovora. Antagonistic assays were carried out in vitro in culture medium and ex vivo in immature loquat and pear fruits. Results revealed that 12% of the 82 bacterial isolates tested were able to inhibit the growth of several strains of the pathogen. Some of the isolates also maintained their antagonistic activity even after chloroform inactivation. Selected isolates were further tested ex vivo, with several of them being able to delay and/or reduce fire blight symptom severity in both loquats and pears and having activity against some E. amylovora strains. The isolates showing the best antagonism also produced different hydrolases linked to biocontrol (protease, lipase, amylase, and/or DNAse) and were able to fix molecular nitrogen. Based on this additional characterization, four biocontrol strain candidates were further selected and identified using MALDI-TOF MS. Three of them were Gram-positive bacteria belonging to Bacillus and Paenarthrobacter genera, and the fourth was a Pseudomonas strain. Results provide promising prospects for an improvement in the biological control strategies against fire blight disease.

Development of TaqMan Real-Time PCR Protocols for Simultaneous Detection and Quantification of the Bacterial Pathogen Ralstonia solanacearum and Their Specific Lytic Bacteriophages.

Ralstonia solanacearum is the causal agent of bacterial wilt, one of the most destructive diseases of solanaceous plants, affecting staple crops worldwide. The bacterium survives in water, soil, and other reservoirs, and is difficult to control. In this sense, the use of three specific lytic R. solanacearum bacteriophages was recently patented for bacterial wilt biocontrol in environmental water and in plants. To optimize their applications, the phages and the bacterium need to be accurately monitored and quantified, which is laborious and time-consuming with biological methods. In this work, primers and TaqMan probes were designed, and duplex and multiplex real-time quantitative PCR (qPCR) protocols were developed and optimized for the simultaneous quantification of R. solanacearum and their phages. The quantification range was established from 108 to 10 PFU/mL for the phages and from 108 to 102 CFU/mL for R. solanacearum. Additionally, the multiplex qPCR protocol was validated for the detection and quantification of the phages with a limit ranging from 102 targets/mL in water and plant extracts to 103 targets/g in soil, and the target bacterium with a limit ranging from 103 targets/mL in water and plant extracts to 104 targets/g in soil, using direct methods of sample preparation.

Remnant cholesterol in patients admitted for acute coronary syndromes.

BACKGROUND: Remnant cholesterol has been identified as one of leading lipid values associated with the incidence of coronary heart disease. There is scarce evidence on its distribution and prognostic value in acute coronary syndrome (ACS) patients. METHODS AND RESULTS: We included all consecutive patients admitted for ACS in two different centres. Remnant cholesterol was calculated by the equation: total cholesterol minus LDL cholesterol minus HDL cholesterol, and values ≥30 were considered high. Among the 7479 patients, median remnant cholesterol level was 28 mg/dL (21-39), and 3429 (45.85%) patients had levels ≥30 mg/dL. Age (r: -0.29) and body mass index (r: 0.44) were the variables more strongly correlated. At any given age, patients with overweigh or obesity had higher levels. In-hospital mortality was 3.75% (280 patients). Remnant cholesterol was not associated to higher in-hospital mortality risk (odds ratio: 0.89; P = 0.21). After discharge (median follow-up of 57 months), an independent and linear risk of all-cause mortality and heart failure (HF) associated to cholesterol remnant levels was observed. Remnant cholesterol levels >60 mg/dL were associated to higher risk of mortality [hazard ratio (HR): 1.49 95% CI 1.08-2.06; P = 0.016], cardiovascular mortality (HR: 1.49 95% CI 1.08-2.06; P = 0.016), and HF re-admission (sub-HR: 1.55 95% CI 1.14-2.11; P = 0.005). CONCLUSIONS: Elevated remnant cholesterol is highly prevalent in patients admitted for ACS and is inversely correlated with age and positively with body mass index. Remnant cholesterol levels were not associated to higher in-hospital mortality risk, but they were associated with higher long-term risk of mortality and HF.

Elevated remnant cholesterol is highly prevalent in patients admitted for ACS and is related to body mass index and negatively with age. Remnant cholesterol it is not associated to higher in-hospital mortality risk, but it confers higher long-term risk of mortality and heart failure.

Differential prognosis of patients that are candidates for standard, short or prolonged dual antiplatelet treatment discharged after an acute coronary syndrome.

BACKGROUND: Current evidence supports the efficacy of prolonged dual antiplatelet treatment (DAPT) for patients at high-ischemic risk and low bleeding risk as well as the efficacy and safety of short DAPT in high-bleeding risk (HBR) patients. METHODS: We evaluated patterns of DAPT candidates in all patients discharged in 2 hospitals after an acute coronary syndrome (ACS). Patients categorized in 3 groups: 1) short-DAPT candidates if they met 1 major o 2 minor criteria for HBR, by the 2019 ARC-HBR criteria; 2) prolonged-DAPT candidates if were not HBR and had recurrent ACS, complex percutaneous coronary interventions or diabetes; 3) standard 12 months DAPT if were not include in the previous 2 groups. Major bleeding (MB) was registered according to 3 or 5 of the BARC consortium definitions. RESULTS: We included 8252 patients and 3215 (39 %) were candidates for abbreviated DAPT, 3119 (37.8 %) for prolonged DAPT, and 1918 (23.2 %) for 12 m DAPT. Relevant differences were observed between the 3 categories beyond the bleeding risk. Median follow-up was 57 months. Multivariate analysis identified higher risk of all-cause mortality (HR: 1.96 95 % CI 1.45-2.67; p < 0.001), cardiovascular mortality (HR: 2.10 95 % CI 1.39-3.19; p < 0.011), MACE (HR: 1.69 95 % 1.50-2.02; p < 0.001) and MB (sHR: 3.41 95 % CI 1.45-8.02; p = 0.005) in candidates to short DAPT. Candidates to prolonged DAPT had higher risk of MACE (HR: 1.17 95 % CI 1.02-1.35; p = 0.027). CONCLUSIONS: Almost two thirds of patients discharged after an ACS would be candidates for short or prolonged DAPT and these patients are at higher risk of MACE and mortality.