Fostamatinib effectiveness and safety for immune thrombocytopenia in clinical practice.

Fostamatinib, a recently approved syk inhibitor used in adult primary immune thrombocytopenia (ITP), has been shown to be safe and effective in this disorder. However, clinical trial results may not be similarly reproduced in clinical practice. Here 138 ITP patients (both primary and secondary) from 42 Spanish centers who had been treated with fostamatinib were evaluated prospectively and retrospectively. The median age of our cohort (55.8% women) was 66 years (interquartile range, IQR, 56-80 years). The median time since ITP diagnosis at fostamatinib initiation was 51 months (IQR, 10-166 months). The median number of therapies prior to fostamatinib initiation was 4 (IQR, 2-5), including eltrombopag (76.1%), romiplostim (57.2%) and intravenous immunoglobulins (IVIG) (44.2%). Fifty-eight patients (42.0%) had signs/symptoms of bleeding in the month prior to treatment initiation. 79.0% of patients responded to fostamatinib with 53.6% complete responses (platelet count > 100 x 109 /L). Eighty-three patients (60.1%) received fostamatinib monotherapy achieving a high response rate (85.4%). The proportion of time in response during the 27-month period examined was 83.3%. The median time to platelet response was 11 days (IQR, 7-21 days). Sixty-seven patients (48.5%) experienced adverse events, mainly grade 1-2, the commonest of which were diarrhea (n = 28) and hypertension (n = 21). One patient had deep venous thrombosis and one patient developed acute myocardial infarction. Fostamatinib was shown to be effective with good safety profile in patients with primary and secondary ITP across a wide age spectrum in this real-world study.

Exploring the Role of Debaryomyces hansenii as Biofertilizer in Iron-Deficient Environments to Enhance Plant Nutrition and Crop Production Sustainability.

The European "Green Deal" policies are shifting toward more sustainable and environmentally conscious agricultural practices, reducing the use of chemical fertilizer and pesticides. This implies exploring alternative strategies. One promising alternative to improve plant nutrition and reinforce plant defenses is the use of beneficial microorganisms in the rhizosphere, such as "Plant-growth-promoting rhizobacteria and fungi". Despite the great abundance of iron (Fe) in the Earth's crust, its poor solubility in calcareous soil makes Fe deficiency a major agricultural issue worldwide. Among plant promoting microorganisms, the yeast Debaryomyces hansenii has been very recently incorporated, for its ability to induce morphological and physiological key responses to Fe deficiency in plants, under hydroponic culture conditions. The present work takes it a step further and explores the potential of D. hansenii to improve plant nutrition and stimulate growth in cucumber plants grown in calcareous soil, where ferric chlorosis is common. Additionally, the study examines D. hansenii's ability to induce systemic resistance (ISR) through a comparative relative expression study by qRT-PCR of ethylene (ET) biosynthesis (ACO1), or ET signaling (EIN2 and EIN3), and salicylic acid (SA) biosynthesis (PAL)-related genes. The results mark a significant milestone since D. hansenii not only enhances nutrient uptake and stimulates plant growth and flower development but could also amplify induced systemic resistance (ISR). Although there is still much work ahead, these findings make D. hansenii a promising candidate to be used for sustainable and environmentally friendly integrated crop management.

Unrestrained Versus Vertically Restrained Loaded Countermovement Jumps: Are There Any Differences in the Components of Force Application?

The objective of this study was to compare a number of variables derived from the vertical and horizontal force components between loaded countermovement jumps performed in a Smith machine (SM modality; vertically restrained jumps) and with free weights (FW modality; unrestrained jumps). Twenty-three recreationally trained individuals, 6 women and 17 men, performed on a 3D force platform 5 maximal countermovement jump trials against 3 external loads (30%, 50%, and 70% of the SM 1-repetition maximum) using the SM and FW jumping modalities on separate sessions. The SM modality promoted greater values for virtually all the variables derived from the vertical force component (maximal force, maximal and minimum velocity, and impulse) and also shorter durations of the braking and propulsive phases. Regardless of the countermovement jump phase (braking or propulsive), the impulse directed toward the backward direction was always considerably greater for the SM compared with the FW modality. These results evidence that for recreationally trained individuals, the SM modality could be more effective to increase the general force capacity of the leg muscles due to increased external stability, while the FW modality is preferable when the orientation of force application is a crucial consideration, as it reduces the horizontal force component.

The impact of maternal morbidity on cesarean section rates: exploring a Latin American network of sentinel facilities using the Robson's Ten Group Classification System.

BACKGROUND: Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson's Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. METHODS: Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. RESULTS: Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). CONCLUSION: Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR.

Effect of the environmental factor of coexistence on the physical condition of people with mild and moderate intellectual disabilities.

BACKGROUND: The main objective of this study was to compare the physical condition of people with intellectual disabilities living in residential homes (RH; restricted residential environment) versus independent homes (IH; family houses while performing paid work). The effect of gender on physical condition was also evaluated separately for each group. METHOD: Sixty individuals with mild to moderate intellectual disability, 30 living in RH and 30 living in IH, participated in this study. The RH and IH groups were homogeneous in terms of gender distribution (17 males and 13 females) and intellectual disability level. Body composition, postural balance, and static and dynamic force were considered as dependent variables. RESULTS: The IH group performed better in the postural balance and dynamic force tests compared to the RH group, but no significant differences between the groups were observed for any body composition or static force variable. Women in both groups tended to have better postural balance than men, while men presented higher dynamic force. CONCLUSIONS: The IH group presented a higher physical fitness compared to RH group. This result emphasises the need to increase the frequency and intensity of the physical activity sessions commonly programed for individuals living in RH.

The influence of meaningful activities in the quality of life and functional autonomy of adults with intellectual disability: A prospective study during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic might negatively impact the quality of life and functional autonomy of Spanish adults with intellectual disability, and meaningful activities could prevent this negative progression. METHODS: This is a prospective cohort study in Spanish adults with intellectual disability during the COVID-19 pandemic. Quality of life, functional autonomy and functional independence were measured. The meaningful activities studied were structured-leisure, community self-management, and occupational and physical activities. RESULTS: Seventy-three participants were included in the study. Quality of life and functional autonomy significantly deteriorated during the COVID-19 pandemic (all p > .001). Greater participation in community self-management activities before COVID-19 was associated with less detriment to quality of life (ß = -.312; p = .008), while greater participation in occupational and physical activities was associated with less detriment to the performance of instrumental activities (ß = -.317; p = .016; and ß = -.285; p = .030, respectively). CONCLUSION: People with intellectual disability living in residential homes experienced a decrease in their quality of life and functional autonomy during the COVID-19 pandemic. Their involvement in community self-management activities and physical and occupational activities before the pandemic had preventive effects on the detriment to the quality of life and functional autonomy.

Employability skills, quality of life, and body composition on employment modalities in individuals with mild and moderate intellectual disabilities.

Background: The inclusion of individuals with intellectual disabilities into the labour market is a challenge in advanced societies, with only a very reduced percentage of these individuals being able to access the free labour market. Whilst some progress has recently been made, there is still a need to further explore the different conditioning factors. Method: A total of 125 users belonging to the three employment modalities of Occupational Workshops (OW), Occupational Centers (OC) and Supported Employment (SE), participated in this study. Differences between modalities were determined for employability, quality of life, and body composition. Results: Employability skills were higher for SE compared to OW and OC; the index of quality of life was higher for OC and SE groups compared to OW; no differences were found in body composition between groups. Conclusions: The quality-of-life index was higher for participants performing remunerated employment modalities and employment skills increased when work was more inclusive.

New Linguistic Description Approach for Time Series and its Application to Bed Restlessness Monitoring for Eldercare.

Time series analysis has been an active area of research for years, with important applications in forecasting or discovery of hidden information such as patterns or anomalies in observed data. In recent years, the use of time series analysis techniques for the generation of descriptions and summaries in natural language of any variable, such as temperature, heart rate or CO2 emission has received increasing attention. Natural language has been recognized as more effective than traditional graphical representations of numerical data in many cases, in particular in situations where a large amount of data needs to be inspected or when the user lacks the necessary background and skills to interpret it. In this work, we describe a novel mechanism to generate linguistic descriptions of time series using natural language and fuzzy logic techniques. The proposed method generates quality summaries capturing the time series features that are relevant for a user in a particular application, and can be easily customized for different domains. This approach has been successfully applied to the generation of linguistic descriptions of bed restlessness data from residents at TigerPlace (Columbia, Missouri), which is used as a case study to illustrate the modeling process and show the quality of the descriptions obtained.

Long-chain PUFA profiles in parental diets induce long-term effects on growth, fatty acid profiles, expression of fatty acid desaturase 2 and selected immune system-related genes in the offspring of gilthead seabream.

The present study investigated the effects of nutritional programming through parental feeding on offspring performance and expression of selected genes related to stress resistance in a marine teleost. Gilthead seabream broodstock were fed diets containing various fish oil (FO)/vegetable oil ratios to determine their effects on offspring performance along embryogenesis, larval development and juvenile on-growing periods. Increased substitution of dietary FO by linseed oil (LO) up to 80 % LO significantly reduced the total number of eggs produced by kg per female per spawn. Moreover, at 30 d after hatching, parental feeding with increasing LO up to 80 % led to up-regulation of the fatty acyl desaturase 2 gene (fads2) that was correlated with the increase in conversion rates of related PUFA. Besides, cyclo-oxygenase 2 (cox2) and TNF-α (tnf-α) gene expression was also up-regulated by the increase in LO in broodstock diets up to 60 or 80 %, respectively. When 4-month-old offspring were challenged with diets having different levels of FO, the lowest growth was found in juveniles from broodstock fed 100 % FO. An increase in LO levels in the broodstock diet up to 60LO raised LC-PUFA levels in the juveniles, regardless of the juvenile's diet. The results showed that it is possible to nutritionally programme gilthead seabream offspring through the modification of the fatty acid profiles of parental diets to improve the growth performance of juveniles fed low FO diets, inducing long-term changes in PUFA metabolism with up-regulation of fads2 expression. The present study provided the first pieces of evidence of the up-regulation of immune system-related genes in the offspring of parents fed increased FO replacement by LO.

Lipid digestion capacity in gilthead seabream (Sparus aurata) from first feeding to commercial size.

To characterise the progression of lipid digestion capacity in gilthead seabream across life cycle, the activities of bile salt-activated lipase (BAL) and phospholipase A2 (PLA2) were determined in the digestive tracts of cultured gilthead seabream from first feeding to marketable size (49 µg to 300 g). Four trials were undertaken with gilthead seabream of different ages, fed on diets with fishmeal and fish oil as the main dietary protein and lipid sources and 21-25% lipid contents. Larvae of 4 days after hatching (dah) to 9 dah were fed rotifers with different fatty acid profiles: control (2.8% eicosapentaenoic acid, EPA; 1.6% docosahexaenoic acid, DHA; 5.4% n-3 long-chain polyunsaturated fatty acids, n-3 LC-PUFAs; and 0.2% arachidonic acid, ARA), low EPA (1.38% EPA, 1.6% DHA, 3.9% n-3 LC-PUFA and 0.4% ARA) or low LC-PUFA (0.7% EPA, 1.0% DHA, 1.8% n-3 LC-PUFA and 0.0% ARA) (% dry weight). Larvae fed the low-LC-PUFA diet showed a significantly lower growth at 10 dah. BAL activities were significantly higher in larvae fed the control diet than in those fed low-EPA and low-LC-PUFA diets at 9 dah. BAL activity increased with age across life cycle (49 µg to 300 g). PLA2 activity could not be detected in larvae but increased with age in juvenile and adult gilthead seabream (86 g to 295 g), similar to BAL. Results suggested a correspondence between the stimulation of lipid digestion capacity and growth performance in gilthead seabream by dietary essential fatty acids, particularly by EPA when DHA requirements are met in the diet especially in the very early stages of life cycle, when the progression of BAL and PLA2 activities could be used as indicators of the nutritional status of cultured gilthead seabream larvae. Finally, regarded that PLA2 activity was not detected in 4-dah to 44-dah gilthead seabream larvae, future works are suggested to assess the dietary effect on PLA2 activity and the PLA2 activity pattern along the larval stage of this species using a more sensitive detection method.

Parental nutritional programming and a reminder during juvenile stage affect growth, lipid metabolism and utilisation in later developmental stages of a marine teleost, the gilthead sea bream (Sparus aurata).

Nutrition during periconception and early development can modulate metabolic routes to prepare the offspring for adverse conditions through a process known as nutritional programming. In gilthead sea bream, replacement of fish oil (FO) with linseed oil (LO) in broodstock diets improves growth in the 4-month-old offspring challenged with low-FO and low-fishmeal (FM) diets for 1 month. The present study further investigated the effects of broodstock feeding on the same offspring when they were 16 months old and were challenged for a second time with the low-FM and low-FO diet for 2 months. The results showed that replacement of parental moderate-FO feeding with LO, combined with juvenile feeding at 4 months old with low-FM and low-FO diets, significantly (P<0·05) improved offspring growth and feed utilisation of low-FM/FO diets even when they were 16 months old: that is, when they were on the verge of their first reproductive season. Liver fatty acid composition was significantly affected by broodstock or reminder diets as well as by their interaction. Moreover, the reduction of long-chain PUFA and increase in α-linolenic acid and linoleic acid in broodstock diets lead to a significant down-regulation of hepatic lipoprotein lipase (P<0·001) and elongation of very long-chain fatty acids protein 6 (P<0·01). Besides, fatty acid desaturase 2 values were positively correlated to hepatic levels of 18 : 4n-3, 18 : 3n-6, 20 : 5n-3, 22 : 6n-3 and 22 : 5n-6. Thus, this study demonstrated the long-term nutritional programming of gilthead sea bream through broodstock feeding, the effect of feeding a 'reminder' diet during juvenile stages to improve utilisation of low-FM/FO diets and fish growth as well as the regulation of gene expression along the fish's life-cycle.

Assessing Impressions of Community Health Worker Use of Tablet-Based Medication Documentation Software.

Community health workers, an important and emerging role in the evolution of the care delivery system, are uniquely positioned to play a vital role in information gathering and exchange. NewYork-Presbyterian Hospital carried out a feasibility study to assess community health worker use and impressions of a medication documentation application that runs on a tablet. The nine community health workers successfully collected data on 16 patients in the home setting. On average, 10 medications were collected per patient, and the average time to collect the medication data was 1 hour. Key findings from the focus groups included the need for additional training and the desire to use the device to streamline other documentation activities. In general, the software was judged to be suitable for the proposed task and represents a starting point for further use of tools that leverage the community health worker in a team-based workflow.

Effect of defence response time during lunge in foil fencing.

The aim of this study was to analyse the effect of stimulus change timing on reaction response time parameters, horizontal velocity of the centre of mass (CM) and precision during offensive actions in fencing. Twelve fencers from the Spanish National Foil Team were included in the study. Two 500 Hz force plates were used to register the horizontal component of the reaction force while a 3D video camera set at 250 Hz recorded the spatial position of 11 body markers and a projector connected to a programmed stopwatch projected a moving target (stimulus) on a screen. When the circle (target) appeared in the centre of the plastron, fencers had to execute a step-forward-lunge as fast as possible, trying to touch the circle with the tip of the foil. During the lunge, the position of the target could randomly shift or not to three different positions. The stimulus change was performed randomly at four different times with a progressive delay. The results show that target changes did not have any effect when they occurred at the beginning of the movement sequence. However, when the target change was delayed, reaction and movement times increased and the technical execution of the lunge changed, leading to more errors.

Time Required to Initiate a Defensive Reaction to Direct and Feint Attacks in Fencing.

The two-fold purpose of this study was to analyze the time required by a fencer to initiate a defensive action in response to a direct attack, which involves identifying when the defending fencer detects the just-noticeable difference, and, secondly, to assess the effect that an attacker's rapid armed hand movement (feint attack) has on the time required to initiate a defensive move. Twenty-four elite fencers and a fencing master were included in the study. Four adapted force plates were installed on a scaffold used as a fencing piste. A 3D video analysis system recorded the location of 2 markers installed on the fencing master's shoulder and sword. The results confirm that the defending fencer has a mean movement time of 0.353 ± 0.028 s to perform the defensive action, which provides an advantage over the attacking fencer. The velocity of movement in the peripheral visual field has no influence on the time required by elite fencers to initiate a defensive action. This confirms the crucial role that response inhibition processes play when nonrelevant actions are perceived. Kinematic analysis of markers suggests that the eye movements of elite fencers are not the only source of information used while observing an attack.

Effect of uncertainty during the lunge in fencing.

The aim of this study is to determine the effect that uncertainty, in relation to the probability of error, exerts on the reaction response and speed during the lunge in fencing. The participants were 18 regional-level fencers with over five years' experience. Force platforms under the feet recorded the horizontal components of the reaction forces, from which the kinematic parameters of the center of mass were calculated. An electronic system to present stimuli, controlled by a programmable clock, projected a target onto a screen that represented a plastron. In situations without uncertainty, the fencers had to lunge as swiftly as possible when a circle (the target) appeared in the center of the plastron, trying to touch the center of the circle with the tip of the sword. In situations with uncertainty, the fencers had the same target as in the previous situation but they received the information that they had to change the lunge into a defensive move if the target disappeared from the plastron during the action. The results indicate that the reaction time and the movement time increased with uncertainty. Although there were no differences for the horizontal velocity of the center of mass at the end of the acceleration phase, the mean horizontal velocity of the lunge was reduced by the effect of the uncertainty. Prior knowledge of the opponent´s possible action implies a reduction in uncertainty, reducing movement time as well as meaning faster execution, thereby increasing the success of the lunge in fencing. Key PointsReaction time (RT) and the movement time (MT) increase when doubts arise about being able to reach the target as planned during the lunge.The horizontal velocity of the lunge decreases by the effect of uncertainty due to the possibility that the events might not occur as planned.These results highlight the importance that tactical intent has in fencing for successfully predicting the defensive movements of the opponent during the attack.

Essential oils: a systematic review on revolutionizing health, nutrition, and omics for optimal well-being.

Purpose: Essential oils from various plants have diverse therapeutic properties and are researched extensively. They have applications in medicine, aromatherapy, microbiology, agriculture, livestock, and the food industry, benefiting the population. Methods: This systematic review followed the PRISMA verification protocol. The study focused on the anti-inflammatory effects, nutraceutical properties, antioxidant and antibacterial activity of essential oils in lemon, orange, cumin, cinnamon, coriander, rosemary, thyme, and parsley. We also looked at their presence in the diet, their effect, their mechanism of action on health, and the most important active compounds. The search was conducted in the PubMed database for the last 12 years of publications, including in vitro, in vivo, and online cell model tests. Results: Essential oils have been shown to have multiple health benefits, primarily due to their antimicrobial and anti-inflammatory effects. The mechanism of action of cinnamon oil alters bacterial membranes, modifies lipid profiles, and inhibits cell division, giving a potential benefit in protection against colitis. On the other hand, a significant improvement was observed in the diastolic pressure of patients with metabolic syndrome when supplementing them with cumin essential oil. The antimicrobial properties of coriander essential oil, especially its application in seafood like tilapia, demonstrate efficacy in improving health and resistance to bacterial infections. Cumin essential oil treats inflammation. Parsley essential oil is an antioxidant. Orange peel oil is antibacterial, antifungal, antiparasitic, and pro-oxidative. Lemon essential oil affects mouse intestinal microbiota. Thyme essential oil protects the colon against damage and DNA methylation. Carnosic acid in rosemary oil can reduce prostate cancer cell viability by modifying the endoplasmic reticulum function. Conclusion and discussion: Essential oils have many therapeutic and antiparasitic properties. They are beneficial to human health in many ways. However, to understand their potential benefits, more research is needed regarding essential oils such as coriander, parsley, rosemary, cumin, and thyme. These research gaps are relevant since they restrict understanding of the possible benefits of these crucial oils for health-related contexts.

Surveillance of COVID-19 vaccines: A comprehensive analysis of the first immunization drive in Ecuador.

The initial phase of the COVID-19 vaccination in Ecuador occurred between April and November 2021. Initially, it focused on priority populations, including health professionals and other front-line workers. During this period, there was limited knowledge about the vaccine's adverse effects. A non-probability, observational study was conducted among university staff in Guayaquil, Ecuador, who received the AstraZeneca vaccine (n = 423) between April and November 2021. This study aimed to compare the acute adverse reactions by doses and to report the incidence of long-term adverse reactions within the AstraZeneca group. As a result, comparing acute adverse reactions between doses, the odds ratio for local pain, headache, muscle pain, fever, and chills are statistically higher after the first dose than the second dose. Survival curves indicated these symptoms appeared mainly within the first 6 h post-vaccination. This is the first pharmacovigilance study from Ecuador that analyzes survival probabilities for the AstraZeneca vaccine's adverse effects.

Physiological pathways involved in nutritional muscle dystrophy and healing in European sea bass (Dicentrarchus labrax) larvae.

The potential muscle regeneration after nutritional dystrophy caused by high dietary DHA contents in fish and the physiological pathways involved are still unknown. To better understand this process, an experiment was conducted for 3 weeks in 14 day-old European sea bass larvae using different DHA ratios (1 or 5%). After this period, part of the larvae fed 5% DHA diet was switched to 1% DHA diet ("wash-out") for another 2 weeks. Larvae fed 5% DHA diet showed altered oxidative status as indicated by the highest TBARS values, antioxidant enzymes (AOE) expression and incidence of muscular lesions. Accordingly, "washed-out" larvae showed lower dry weight and α-TOH content. IGF-I gene expression was elevated in 5% DHA larvae at 35 dph, suggesting increased muscle mitogenesis that was corroborated by the increase in myosin heavy chain expression. It can be concluded that high dietary DHA contents alter the oxidative status and cause muscular lesions in European sea bass larvae, with morphological and molecular aspects of mammalians muscular degenerative disease.

Interstrand crosslinking of homologous repair template DNA enhances gene editing in human cells.

We describe a strategy to boost the efficiency of gene editing via homology-directed repair (HDR) by covalently modifying the template DNA with interstrand crosslinks. Crosslinked templates (xHDRTs) increase Cas9-mediated editing efficiencies by up to fivefold in K562, HEK293T, U2OS, iPS and primary T cells. Increased editing from xHDRTs is driven by events on the template molecule and requires ataxia telangiectasia and Rad3-related (ATR) kinase and components of the Fanconi anemia pathway.