Prevalence of post-COVID-19 in patients with fibromyalgia: a comparative study with other inflammatory and autoimmune rheumatic diseases.

OBJECTIVES: To determine the prevalence and characteristics of post-COVID-19 (PC) in fibromyalgia (FM) patients. METHODS: Retrospective, multi-centric, observational study, comparing a group of FM patients (FM group) with another group of patients with other rheumatic diseases (RD group). COVID-19 diagnosis was established by positive polymerase chain reaction or antigen during acute infection or by positive antibodies thereafter. We considered PC diagnosis when symptoms remain after COVID-19. We collected the principal characteristics of COVID-19, the severity of fatigue, waking unrefreshed and cognitive impairment, and persistent symptoms. The American College of Rheumatology (ACR) criteria and the Combined Index of Severity in Fibromyalgia (ICAF) were collected in the FM group. RESULTS: RD group (n = 56) had more pneumonia (p = 0.001) and hospital admissions (p = 0.002), but the FM group (n = 78) had a higher number of symptoms (p = 0.002). The percentage of patients with PC was similar between groups (FM group 79.5%; RD group 66.1%, p = 0.081). FM group had more PC symptoms (p = 0.001), more impairment after COVID-19 (p = 0.002) and higher severity of fatigue, waking unrefreshed and cognitive impairment (p <  0.0001). Only loss of smell was more frequent in the FM group (p = 0.005). The FM group with PC (n = 29) showed more severity of the Combined Index of Severity in Fibromyalgia (ICAF) total score and physical factor after COVID-19, while emotional, coping factors and the ACR criteria did not change. CONCLUSIONS: The prevalence of PC in FM patients is similar to RD patients. In FM patients, the presence of PC does not appear to impact the severity of FM.

[Identity Diffusion Among Adolescents - Validation of the Inventory of Personality Organization in a Clinical Adolescent Sample (IPO-A)]. / Identitätsdiffusion im Jugendalter ­ Validierung eines Fragebogens zur Erfassung der Persönlichkeitsorganisation (IPO) bei klinisch behandelten Jugendlichen.

Identity Diffusion Among Adolescents - Validation of the Inventory of Personality Organization in a Clinical Adolescent Sample (IPO-A) The main objective of the current study was to analyze the psychometric properties of the German version of the Inventory of Personality Organization for Adolescents (IPO-A). The instrument consisting of 91 items is based on the theoretical structural model by Kernberg and investigates the severity of identity diffusion, reality testing and defense mechanisms in order to determine the level of personality organization. The factor structure, the internal consistency and the convergent validity was measured among 144 inpatients aged between 13 and 18 years drawn from the Child and Adolescent Psychiatry of the University Clinic of Cologne. The investigation revealed a five factor structure: identity diffusion, reality testing, defense mechanisms, aggression and instability of goals. Moreover, testing the psychometric properties of the instrument showed a high internal consistency and meaningful significant correlations with well-validated youth self-report instruments assessing personality pathology and psychopathology. Thus, the results indicate that the IPO-A can be considered to be a reliable instrument that measures personality organization and identity diffusion in adolescents with personality disorders.

[Transference Focused Psychotherapy for Borderline-Adolescents in a Day Clinic Treatment Program]. / Übertragungsfokussierte Psychotherapie von Borderline-Jugendlichen im tagesklinischen Setting.

Transference Focused Psychotherapy for Borderline-Adolescents in a Day Clinic Treatment Program This paper focuses on the concept of transference focused psychotherapy (TFP) modified for juvenile borderline patients. Adolescents with borderline developmental personality disorder (bpd) have an essential deficit in their personality structure that leads to oscillations in their self-esteem and in a "split" perception of the world. They suffer from a variety of symptoms and severe impairments on their own and their families' quality of life. Their fragmented perception of themselves and others make relationships almost unbearable for them. Relationships are mostly marked by severe anxiety of resentment and rejection. For these patients this causes intolerable trouble at school where every day conflicts take place. Self-mutilation and suicidal thoughts often seem the only way out. By now, there is an agreement that an early specialized assessment and treatment is necessary in order to stop the typical consequences of their self-mutilative and dysfunctional behavior. Still, in contrast to adult age, empirical evidence is missing which proves the effectiveness of treating adolescent borderline patients. In this paper we present a research project on the effectiveness of transference focused psychotherapy with adolescent borderline patients (TFP-A) in a day clinic setting, combining TFP with group skills training as known from dialectic behavior therapy (DBT). Furthermore, we give first results on analyzing the effectiveness of our day clinic treatment program based on TFP-A, focusing on improving core symptoms such as affective problems, aggressive behavior against self and others and interpersonal problems.

Development of a calcium phosphate nanocomposite for fast fluorogenic detection of bacteria.

Current procedures for the detection and identification of bacterial infections are laborious, time-consuming, and require a high workload and well-equipped laboratories. Therefore the work presented herein developed a simple, fast, and low cost method for bacterial detection based on hydroxyapatite nanoparticles with a nutritive mixture and the fluorogenic substrate. Calcium phosphate ceramic nanoparticles were characterized and integrated with a nutritive mixture for the early detection of bacteria by visual as well as fluorescence spectroscopy techniques. The composite was obtained by combining calcium phosphate nanoparticles (Ca:P ratio, 1.33:1) with a nutritive mixture of protein hydrolysates and carbon sources, which promote fast bacterial multiplication, and the fluorogenic substrate 4-methylumbellipheryl-ß-D-glucuronide (MUG). The composite had an average particle size of 173.2 nm and did not show antibacterial activity against Gram-negative or Gram-positive bacteria. After an Escherichia coli suspension was in contact with the composite for 60-90 min, fluorescence detected under UV light or by fluorescence spectrophotometer indicated the presence of bacteria. Intense fluorescence was observed after incubation for a maximum of 90 min. Thus, this calcium phosphate nanocomposite system may be useful as a model for the development of other nanoparticle composites for detection of early bacterial adhesion.

Composites of Poly(3-hydroxybutyrate) and Mesoporous SBA-15 Silica: Crystalline Characteristics, Confinement and Final Properties.

Several composites based on poly(3-hydroxybutyrate) (PHB) and mesoporous SBA-15 silica were prepared by solvent-casting followed by a further stage of compression molding. The thermal stability, phase transitions and crystalline details of these composites were studied, paying special attention to the confinement of the PHB polymeric chains into the mesopores of the silica. For that, differential scanning calorimetry (DSC) and real-time variable-temperature X-ray scattering at small angles (SAXS) were performed. Confinement was stated first by the existence of a small endotherm at temperatures around 20 °C below the main melting or crystallization peak, being later confirmed by a notable discontinuity in the intensity of the main (100) diffraction from the mesoporous silica observed through SAXS experiments, which is related to the change in the scattering contrast before and after the crystallization or melting of the polymer chains. Furthermore, the usual α modification of PHB was developed in all samples. Finally, a preliminary investigation of mechanical and relaxation parameters was carried out through dynamic-mechanical thermal analysis (DMTA). The results show, in the temperature interval analyzed, two relaxations, named α and ß (the latest related to the glass transition) in order of decreasing temperatures, in all specimens. The role of silica as a filler is mainly observed at temperatures higher than the glass transition. In such cases, stiffness is dependent on SBA-15 content.

Combined Effects from Dual Incorporation of ATBC as Plasticizer and Mesoporous MCM-41 as Nucleating Agent on the PLA Isothermal Crystallization in Environmentally-Friendly Ternary Composite Systems.

Different materials, based on an L-rich polylactide (PLA) as matrix, acetyl tri-n-butyl citrate (ATBC) as plasticizer, and mesoporous Mobile Crystalline Material.41 (MCM-41) particles as nucleating agent, were attained by melt extrusion. These materials are constituted by (a) binary blends of PLA and ATBC with different contents of the latest; (b) a dual compound of PLA and a given amount of MCM-41 silica (5 wt.%); and (c) ternary composites that include PLA, ATBC at several compositions and mesoporous MCM-41 at 5 wt.%. Influence of the incorporation of the plasticizer and nucleating particles has been comprehensively analyzed on the different phase transitions: glass transition, cold crystallization, melt crystallization and melting processes. Presence of both additives moves down the temperature at which PLA phase transitions take place, while allowing the PLA crystallization from the melt at 10 °C/min in the composites. This tridimensional ordering is not noticeable in the pristine PLA matrix and, accordingly, PLA crystallization rate is considerably increased under dynamic conditions and also after isothermal crystallization from either the melt or the glassy state. An important synergistic effect of dual action of ATBC and MCM-41 has been, therefore, found.

Antimicrobial Activity and Crystallization Features in Bio-Based Composites of PLLA and MCM-41 Particles Either Pristine or Functionalized with Confined Ag Nanowires.

Composites based on an L-rich poly(lactic acid) (PLLA) and MCM-41, either neat or modified with a silver (MCM-41@Ag), are achieved by solvent casting, being next processed by compression molding. Ag is mainly embedded as nanowires within the hybrid MCM-41@Ag particles, enabling its antimicrobial character. In these composites, the PLLA thermal stability, nucleation efficiency, and mechanical response are dependent on the MCM-41 nature and, to a lesser extent, on its content. Thus, differences in transitions of the PLLA matrix are noticed during cooling at 10 °C/min and in the subsequent heating when composites with neat or modified MCM-41 are compared. A very remarkable nucleation effect is played by pristine MCM-41, being inferior when MCM-41@Ag is incorporated into the PLLA. Wide angle X-ray scattering (WAXS) measurements using synchrotron radiation and performed under variable-temperature conditions in the composites containing MCM-41@Ag indicate that during cold crystallization, the disordered α' polymorph is initially formed, but it rapidly transforms into ordered α crystals. A long spacing peak, clearly seen in pure PLLA, appears as a small shoulder in PLLAMCM@Ag4 and is undetectable in PLLAMCM@Ag9 and PLLAMCM@Ag20. Furthermore, an increase in MH with the silica content is found in the two sets of composites, the higher MH values being observed in the family of PLLA and MCM-41@Ag. Finally, remarkable antimicrobial features are noticeable in the composites with MCM-41@Ag since this modified silica transfers its biocidal characteristics into the PLLA composites.

Hepatic fatty acid translocase CD36 upregulation is associated with insulin resistance, hyperinsulinaemia and increased steatosis in non-alcoholic steatohepatitis and chronic hepatitis C.

BACKGROUND: Fatty acid translocase CD36 (FAT/CD36) mediates uptake and intracellular transport of long-chain fatty acids in diverse cell types. While the pathogenic role of FAT/CD36 in hepatic steatosis in rodents is well-defined, little is known about its significance in human liver diseases. OBJECTIVE: To examine the expression of FAT/CD36 and its cellular and subcellular distribution within the liver of patients with non-alcoholic fatty liver disease (NAFLD) and chronic hepatitis C virus (HCV) infection. PATIENTS: 34 patients with non-alcoholic steatosis (NAS), 30 with non-alcoholic steatohepatitis (NASH), 66 with HCV genotype 1 (HCV G1) and 32 with non-diseased liver (NL). METHODS: Real-time PCR and western blot analysis were used to assess hepatic FAT/CD36 expression. Computational image analysis of immunostained liver biopsy sections was performed to determine subcellular distribution and FAT/CD36 expression index. RESULTS: Compared with NL, hepatic mRNA and protein levels of FAT/CD36 were significantly higher in patients with NAS (median fold increase 0.84 (range 0.15-1.61) and 0.66 (range 0.33-1.06), respectively); NASH (0.91 (0.22-1.81) and 0.81 (0.38-0.92), respectively); HCV G1 without steatosis (0.30 (0.17-1.59) and 0.33 (0.29-0.52), respectively); and HCV G1 with steatosis (0.85 (0.15-1.98) and 0.87 (0.52-1.26), respectively). In contrast to NL, FAT/CD36 was predominantly located at the plasma membrane of hepatocytes in patients with NAFLD and HCV G1 with steatosis. A significant correlation was observed between hepatic FAT/CD36 expression index and plasma insulin levels, insulin resistance (HOMA-IR) and histological grade of steatosis in patients with NASH (r=0.663, r=0.735 and r=0.711, respectively) and those with HCV G1 with steatosis (r=0.723, r=0.769 and r=0.648, respectively). CONCLUSIONS: Hepatic FAT/CD36 upregulation is significantly associated with insulin resistance, hyperinsulinaemia and increased steatosis in patients with NASH and HCV G1 with fatty liver. Translocation of this fatty acid transporter to the plasma membrane of hepatocytes may contribute to liver fat accumulation in patients with NAFLD and HCV.

Influence of Content in D Isomer and Incorporation of SBA-15 Silica on the Crystallization Ability and Mechanical Properties in PLLA Based Materials.

Two L-rich polylactides (PLLA) with distinct contents in D isomer and their composites with an intermediate amount of mesoporous Santa Barbara Amorphous-15 (SBA-15) (about 9 wt.%) particles were attained by melt extrusion for the evaluation of the effect of content in D isomer and incorporation of mesoporous silica on the structural PLLA features and on their ultimate mechanical performance. For that, samples have been crystallized under dynamic and isothermal tests (from the melt and from the glassy states). The results from DSC and X-ray diffraction show obtainment of the pure α' and α modifications at different intervals of crystallization temperature depending on the D steroisomer amount of the PLLA used. Furthermore, several phase transitions are observed depending on the crystallinity reached and the polymorphs developed during the isothermal crystallization from the glass: an additional cold crystallization, the α'/α transformation and the subsequent melting process, appearing all of them at temperatures clearly dependent on the D content. Rigidity, measured through microhardness in amorphous samples, is also affected by the D isomer and the presence of SBA-15 particles. Reinforcement effect of mesoporous silica is relatively more important in the matrix with the highest D content.

Longitudinal Analysis of Adolescent Adjustment: The Role of Attachment and Emotional Competence.

Emotional competencies as well as secure attachment relationships with peers are protective factors that facilitate psychological adjustment among adolescents. In this study, we will analyse how these socio-emotional factors influence adolescents' emotional symptoms, conduct problems and peer problems. The participants were 815 Spanish adolescents aged 12-17 years (M = 13.69; SD = 1.21) who completed the Strengths and Difficulties Questionnaire (SDQ), the Parent and Peer Attachment Inventory (IPPA) and the Emotional Skills and Competence Questionnaire (ESCQ). Besides descriptive analyses, such as Pearson's bivariate correlations, two different methodologies were combined to predict adolescent adjustment: structural equation modelling (SEM) and fuzzy set qualitative comparative analysis (fsQCA). The results show that secure attachment with peers and high emotional competence predict better psychological adjustment (low levels of emotional symptoms, conduct problems and peer problems), while insecure peer attachment and low emotional competence predict maladjustment. These results emphasise the role of socio-emotional variables in the promotion of psychological adjustment in adolescence through the implementation of emotional education programs.

Recycling of metallocene isotactic polypropylene: importance of antioxidants.

Recycling of plastics is absolutely essential in a circular economy, especially in the case of commodity polymers from fossil resources, like isotactic polypropylene (iPP). Therefore, evaluation of the factors that are decisive for an optimum performance of the recycled based materials becomes mandatory for the obtainment of new products with optimal properties. One of the most important aspects is the protection of the plastics materials not only against the external degradation agents, but also from the radicals generated during their previous service life. Accordingly, several materials have been prepared by extrusion based on virgin iPP with different amounts of the same polypropylene severely degraded, which has been used as model component to be recycled. Previous to the extrusion, a mixture of antioxidants was added to all the samples, and special attention has been paid to consumption of those additives during the extrusion. The results show an increasing reduction of antioxidants with rising content of the degraded material. But, importantly, a rather analogous mechanical response has been found for all the recycled materials in relation to the virgin iPP, pointing out a satisfactory dilution effect of the existing degradation points within the virgin polymeric chains, and indicating the very relevant action of the antioxidants used.

Hepatic insulin resistance is associated with increased apoptosis and fibrogenesis in nonalcoholic steatohepatitis and chronic hepatitis C.

BACKGROUND & AIMS: We aimed to elucidate whether hepatic insulin resistance may contribute to hepatocyte apoptosis and fibrogenesis in nonalcoholic fatty liver disease (NAFLD) and in chronic hepatitis C virus (HCV) infection. METHODS: Twenty-seven nonalcoholic steatosis (NAST), 24 nonalcoholic steatohepatitis (NASH), 71 HCV, and 29 patients with histological normal liver (NL) were studied. Real-time PCR, the TUNEL assay, and Western blots were used to assess insulin-signaling molecules, hepatocyte apoptosis, antiapoptotic mediators, active caspase 3, and type I collagen in liver biopsies. HCV core-transfected human hepatocytes were used as an in vitro model. RESULTS: In NAFLD patients, hepatic levels of insulin receptor substrate (IRS) 1, IRS2 2, the p85α subunit of phosphatidylinositol 3-kinase (p85α), phosphorylated protein kinase B (pAkt), phosphorylated forkhead box-containing protein O subfamily-1 (FoxO), and phosphorylated 5' adenosine monophosphate-activated protein kinase (pAMPK) as well as the antiapoptotic mediators B-cell lymphoma 2 protein (Bcl-2) and myeloid cell leukemia protein-1 (Mcl-1) were significantly lower in NASH than in NAST and NL. Furthermore, hepatocyte apoptosis and increased active caspase 3 were only present in NASH. In HCV patients, hepatic insulin signaling was markedly impaired, regardless of viral genotype and the presence of steatosis paralleled with enhanced apoptosis. In cultured human hepatocytes, HCV core protein decreased pAkt and increased phosphorylation of c-Jun N-terminal kinase (JNK). This effect was more pronounced in lipid-loaded hepatocytes. CONCLUSIONS: Hepatic insulin signaling is impaired in NASH and HCV patients, and downregulation of insulin-sensitive targets is associated with increased apoptosis and fibrogenesis in both conditions. JNK might be a target for HCV-induced insulin resistance.

Enhanced expression of pro-inflammatory mediators and liver X-receptor-regulated lipogenic genes in non-alcoholic fatty liver disease and hepatitis C.

NAFLD (non-alcoholic fatty liver disease) is one of the most frequent chronic liver diseases worldwide. The metabolic factors associated with NAFLD are also determinants of liver disease progression in chronic HCV (hepatitis C virus) infection. It has been reported that, besides inducing hepatic fatty acid biosynthesis, LXR (liver X receptor) regulates a set of inflammatory genes. We aimed to evaluate the hepatic expression of LXRα and its lipogenic and inflammatory targets in 43 patients with NAFLD, 44 with chronic HCV infection and in 22 with histologically normal liver. Real-time PCR and Western blot analysis were used to determine hepatic expression levels of LXRα and related lipogenic and inflammatory mediators in the study population. We found that the LXRα gene and its lipogenic targets PPAR-γ (peroxisome-proliferator-activated receptor-γ), SREBP (sterol-regulatory-element-binding protein)-1c, SREBP-2 and FAS (fatty acid synthase) were overexpressed in the liver of NAFLD and HCV patients who had steatosis. Moreover, up-regulation of inflammatory genes, such as TNF (tumour necrosis factor)-α, IL (interleukin)-6, OPN (osteopontin), iNOS (inducible NO synthase), COX (cyclo-oxygenase)-2 and SOCS (suppressors of cytokine signalling)-3, was observed in NAFLD and HCV patients. Interestingly, TNF-α, IL-6 and osteopontin gene expression was lower in patients with steatohepatitis than in those with steatosis. In conclusion, hepatic expression of LXRα and its related lipogenic and inflammatory genes is abnormally increased in NAFLD and HCV patients with steatosis, suggesting a potential role of LXRα in the pathogenesis of hepatic steatosis in these chronic liver diseases.

Refractory fibromyalgia.

In the medical literature, there are only a few references on refractory fibromyalgia and there is no consensus definition available on this concept. Some definitions of refractory fibromyalgia have been proposed based on the lack of response to a number of medications, and perhaps the most appropriate term is treatment-refractory fibromyalgia. To achieve the definition of treatment-refractory fibromyalgia, it is necessary to consider several previous steps, such as making sure the diagnosis has been made properly and a differential diagnosis with entities that can mimic fibromyalgia symptoms (including complete physical examination and laboratory test) has been made. The possibility that another factor that alters the response to treatment should be investigated, and in particular review all prescribed medication and search for some non-medical reasons that could mask the response to treatment (e.g., legal compensation). The definition of refractory fibromyalgia is complex and probably should include a lack of response to a specified number of drugs or to combination therapy with at least two non-pharmacological measures. In this article, it is not our purpose to present a formal definition, but to raise the possible bases for this purpose. We believe that it is a subject that must be discussed extensively before reaching a consensus definition. Key Points • There is no appropriate definition to classify fibromyalgia patients who do not respond to the usual pharmacological and non-pharmacological measures according to the national or international guidelines. • A consensus definition is required to classify these patients, which could help standardize future management strategies. In this article, we propose the bases on which refractory fibromyalgia could be defined.

Coinfections among hospitalized patients with covid-19 in the first pandemic wave.

BACKGROUND: COVID19 is the novel respiratory illness caused by SARS-CoV-2. The presence of other potentially pathogenic microorganisms could worsen the prognosis of these patients. AIM: The study aims to describe coinfections in COVID-19 patients and contrast it between standard ward and critical care patients at Hospital Central de la Defensa Gómez Ulla (HCDGU). METHODS: A retrospective study was carried out of patients with COVID-19 confirmed with RTPCR admitted to the HCDGU from March 5, 2020 to May 7 of 2020. FINDINGS: Of a total of 703 patients with COVID-19, 75(10.7%) had other microbiologically confirmed infections: 9% (58/648) in standard ward patients and 31.5%(17/54) in critical care patients. In total 86 samples of the 75 patients presented some microorganism; clinically relevant bacteraemias, 50%, respiratory cultures, 32.6% and pneumococcal positive antigens, 17.4%. CONCLUSIONS: We found a low frequency of microorganism coinfection in COVID-19 patients, however in critical care these coinfections increased considerably.

Nanocomposites of PCL and SBA-15 Particles Prepared by Extrusion: Structural Characteristics, Confinement of PCL Chains within SBA-15 Nanometric Channels and Mechanical Behavior.

A study of different nanocomposites based on poly(ε-caprolactone) (PCL) and mesoporous SBA-15 silica that were prepared by melt extrusion was carried out by analyzing the possible effect of this filler on the crystalline details of PCL, on its mechanical behavior, and on the eventual observation of the confinement of the polymeric chains within the hollow nanometric silica channels. Thus, simultaneous Small-Angle and Wide-Angle X-ray Scattering (SAXS/WAXS) synchrotron experiments at variable temperature were performed on these PCL nanocomposites with different mesoporous silica contents. The importance of the morphological and structural features was assessed by the changes that were observed during the mechanical response of the final materials, which determined that the presence of mesoporous particles leads to a noticeable reinforcing effect.

Composites Based on Poly(Lactic Acid) (PLA) and SBA-15: Effect of Mesoporous Silica on Thermal Stability and on Isothermal Crystallization from Either Glass or Molten State.

Several composites based on an L-rich poly(lactic acid) (PLA) with different contents of mesoporous Santa Barbara Amorphous (SBA-15) silica were prepared in order to evaluate the effect of the mesoporous silica on the resultant PLA materials by examining morphological aspects, changes in PLA phases and their transitions, and, primarily, the influence on some final properties. Melt extrusion was chosen for the obtainment of the composites, followed by quenching from the melt to prepare films. Completely amorphous samples were then attained, as deduced from X-ray diffraction and differential scanning calorimetry (DSC) analyses. Thermogravimetric analysis (TGA) results demonstrated that the presence of SBA-15 particles in the PLA matrix did not exert any significant influence on the thermal decomposition of these composites. An important nucleation effect of the silica was found in PLA, especially under isothermal crystallization either from the melt or from its glassy state. As expected, isothermal crystallization from the glass was considerably faster than from the molten state, and these high differences were also responsible for a more considerable nucleating role of SBA-15 when crystallizing from the melt. It is remarkable that the PLA under analysis showed very close temperatures for cold crystallization and its subsequent melting. Moreover, the type of developed polymorphs did not accomplish the common rules previously described in the literature. Thus, all the isothermal experiments led to exclusive formation of the α modification, and the observation of the α' crystals required the annealing for long times at temperatures below 80 °C, as ascertained by both DSC and X-ray diffraction experiments. Finally, microhardness (MH) measurements indicated a competition between the PLA physical aging and the silica reinforcement effect in the as-processed amorphous films. Physical aging in the neat PLA was much more important than in the PLA matrix that constituted the composites. Accordingly, the MH trend with SBA-15 content was strongly dependent on aging times.

Physiopathological Bases of the Disease Caused by HACE1 Mutations: Alterations in Autophagy, Mitophagy and Oxidative Stress Response.

Recessive HACE1 mutations are associated with a severe neurodevelopmental disorder (OMIM: 616756). However, the physiopathologycal bases of the disease are yet to be completely clarified. Whole-exome sequencing identified homozygous HACE1 mutations (c.240C>A, p.Cys80Ter) in a patient with brain atrophy, psychomotor retardation and 3-methylglutaconic aciduria, a biomarker of mitochondrial dysfunction. To elucidate the pathomechanisms underlying HACE1 deficiency, a comprehensive molecular analysis was performed in patient fibroblasts. Western Blot demonstrated the deleterious effect of the mutation, as the complete absence of HACE1 protein was observed. Immunofluorescence studies showed an increased number of LC3 puncta together with the normal initiation of the autophagic cascade, indicating a reduction in the autophagic flux. Oxidative stress response was also impaired in HACE1 fibroblasts, as shown by the reduced NQO1 and Hmox1 mRNA levels observed in H2O2-treated cells. High levels of lipid peroxidation, consistent with accumulated oxidative damage, were also detected. Although the patient phenotype could resemble a mitochondrial defect, the analysis of the mitochondrial function showed no major abnormalities. However, an important increase in mitochondrial oxidative stress markers and a strong reduction in the mitophagic flux were observed, suggesting that the recycling of damaged mitochondria might be targeted in HACE1 cells. In summary, we demonstrate for the first time that the impairment of autophagy, mitophagy and oxidative damage response might be involved in the pathogenesis of HACE1 deficiency.

Clinical Feasibility and Airway Deposition of Nebulized Voriconazole in Healthy Horses.

Voriconazole (VRC) is a potential treatment for pneumomycosis in horses. The objectives of this study were to determine if the delivery of Vfend using a Flexineb nebulizer produced clinically significant [VRC] in lower airways. The hypothesis was that [VRC] after delivery by nebulization would be greater in the pulmonary epithelial lining fluid than plasma. A secondary objective was to determine [VRC] in upper airways through the collection of nasopharyngeal wash (NPW) samples. Voriconazole solution [Vfend-6.25 mg/mL, 100 (n = 2), 200 (n = 3), 500 (n = 1) mg] was nebulized once in 6 healthy geldings. Clinical responses, duration of nebulization, and [VRC] at various time points (up to 8 hours) in plasma, bronchoalveolar lavage fluid (BALF) supernatant and cell pellet, and NPW samples were recorded. Voriconazole (Vfend-6.25 mg/mL, 200 mg) was nebulized in 5 additional, healthy geldings, and [VRC] was measured in NPW samples pre- and postnebulization at time points up to 8 hours. The antifungal activity of BALF and NPW samples was determined using agar disk diffusion. Concentrations of voriconazole were below detection in plasma, BALF supernatant, and cell pellets for all time points and doses except the BALF cell pellet (0.4 µg/g) immediately after nebulization of 500 mg. For 5 horses, administered 200 mg of Vfend, mean [VCR] in NPW at the end of nebulization and 1, 6, and 8 hours postnebulization were: 30.8 ± 29, 1.0 ± 0.84, 0.2 ± 0.19, and 0.34 ± 0.67 µg/mL, respectively. Only NPW samples obtained immediately postnebulization showed antifungal activity. A nebulized Vfend solution is not recommended for the treatment of pneumomycosis in horses.

Mitochondrial Dysfunction: A Common Hallmark Underlying Comorbidity between sIBM and Other Degenerative and Age-Related Diseases.

Sporadic inclusion body myositis (sIBM) is an inflammatory myopathy associated, among others, with mitochondrial dysfunction. Similar molecular features are found in Alzheimer's disease (AD) and Type 2 Diabetes Mellitus (T2DM), underlying potential comorbidity. This study aims to evaluate common clinical and molecular hallmarks among sIBM, AD, and T2DM. Comorbidity with AD was assessed in n = 14 sIBM patients by performing neuropsychological and cognitive tests, cranial magnetic resonance imaging, AD cerebrospinal fluid biomarkers (levels of amyloid beta, total tau, and phosphorylated tau at threonine-181), and genetic apolipoprotein E genotyping. In the same sIBM cohort, comorbidity with T2DM was assessed by collecting anthropometric measures and performing an oral glucose tolerance test and insulin determinations. Results were compared to the standard population and other myositis (n = 7 dermatomyositis and n = 7 polymyositis). Mitochondrial contribution into disease was tested by measurement of oxidative/anaerobic and oxidant/antioxidant balances, respiration fluxes, and enzymatic activities in sIBM fibroblasts subjected to different glucose levels. Comorbidity of sIBM with AD was not detected. Clinically, sIBM patients showed signs of misbalanced glucose homeostasis, similar to other myositis. Such misbalance was further confirmed at the molecular level by the metabolic inability of sIBM fibroblasts to adapt to different glucose conditions. Under the standard condition, sIBM fibroblasts showed decreased respiration (0.71 ± 0.08 vs. 1.06 ± 0.04 nmols O2/min; p = 0.024) and increased anaerobic metabolism (5.76 ± 0.52 vs. 3.79 ± 0.35 mM lactate; p = 0.052). Moreover, when glucose conditions were changed, sIBM fibroblasts presented decreased fold change in mitochondrial enzymatic activities (-12.13 ± 21.86 vs. 199.22 ± 62.52 cytochrome c oxidase/citrate synthase ratio; p = 0.017) and increased oxidative stress per mitochondrial activity (203.76 ± 82.77 vs. -69.55 ± 21.00; p = 0.047), underlying scarce metabolic plasticity. These findings do not demonstrate higher prevalence of AD in sIBM patients, but evidences of prediabetogenic conditions were found. Glucose deregulation in myositis suggests the contribution of lifestyle conditions, such as restricted mobility. Additionally, molecular evidences from sIBM fibroblasts confirm that mitochondrial dysfunction may play a role. Monitoring T2DM development and mitochondrial contribution to disease in myositis patients could set a path for novel therapeutic options.