[Translated article] Immune-Mediated Skin Reactions to Tumor Necrosis α Inhibitors: A Review of 30 Cases

BACKGROUND

Tumor necrosis factor α (TNF) inhibitors are used to treat different inflammatory diseases. Although these biologics have an adequate safety profile, they have been associated with paradoxical reactions.

MATERIAL AND METHODS

Retrospective review of patients on TNF inhibitor therapy who developed a paradoxical skin reaction and were seen at the dermatology department of Hospital Universitari Parc Taulí in Sabadell, Spain.

RESULTS

We collected data on 30 patients under treatment with a TNF inhibitor who developed an immune-mediated skin reaction in the form of psoriasis (90%), alopecia (6.7%), or neutrophilic dermatitis (3.3%). The most common drugs involved were adalimumab (56.7%) and infliximab (40%). Psoriasiform reactions mostly manifested as generalized plaques (62.9%) or palmoplantar pustulosis (37%). Thirteen patients (43.3%) continued on the same TNF inhibitor and 12 of them (92.3%) achieved partial or complete resolution of lesions. Five patients were switched to a different TNF inhibitor, but none of them achieved complete resolution. Eight patients were switched to a biologic with a different target, and 5 of them (62.5%) achieved partial or complete resolution.

CONCLUSIONS

Paradoxical reactions during TNF inhibitor therapy do not always require a change of treatment. In our series, the addition of a topical and/or systemic treatment resolved the skin lesions in more than half of the patients, and switching to a drug with a different target was more effective. A change of strategy should be contemplated in more serious cases.

Immune-Mediated Skin Reactions to Tumor Necrosis α Inhibitors: A Review of 30 Cases

BACKGROUND

Tumor necrosis factor α (TNF) inhibitors are used to treat different inflammatory diseases. Although these biologics have an adequate safety profile, they have been associated with paradoxical reactions.

MATERIAL AND METHODS

Retrospective review of patients on TNF inhibitor therapy who developed a paradoxical skin reaction and were seen at the dermatology department of Hospital Universitari Parc Taulí in Sabadell, Spain.

RESULTS

We collected data on 30 patients under treatment with a TNF inhibitor who developed an immune-mediated skin reaction in the form of psoriasis (90%), alopecia (6.7%), or neutrophilic dermatitis (3.3%). The most common drugs involved were adalimumab (56.7%) and infliximab (40%). Psoriasiform reactions mostly manifested as generalized plaques (62.9%) or palmoplantar pustulosis (37%). Thirteen patients (43.3%) continued on the same TNF inhibitor and 12 of them (92.3%) achieved partial or complete resolution of lesions. Five patients were switched to a different TNF inhibitor, but none of them achieved complete resolution. Eight patients were switched to a biologic with a different target, and 5 of them (62.5%) achieved partial or complete resolution.

CONCLUSIONS

Paradoxical reactions during TNF inhibitor therapy do not always require a change of treatment. In our series, the addition of a topical and/or systemic treatment resolved the skin lesions in more than half of the patients, and switching to a drug with a different target was more effective. A change of strategy should be contemplated in more serious cases.

Afforestation and climate mitigation: lessons from Chile

The Chilean Climate Change Law excludes tree monocultures as a solution to the climate crisis, offering an opportunity for resilience and climate mitigation in Latin America. The Chilean experience with mega-fires in extensive, homogeneous forest plantations provides important lessons that could inform climate policies in other countries.

Widespread synchronous decline of Mediterranean-type forest driven by accelerated aridity

Large-scale, abrupt ecosystem change in direct response to climate extremes is a critical but poorly documented phenomenon1. Yet, recent increases in climate-induced tree mortality raise concern that some forest ecosystems are on the brink of collapse across wide environmental gradients2,3. Here we assessed climatic and productivity trends across the world's five Mediterranean forest ecosystems from 2000 to 2021 and detected a large-scale, abrupt forest browning and productivity decline in Chile (>90% of the forest in <100 days), responding to a sustained, acute drought. The extreme dry and warm conditions in Chile, unprecedented in the recent history of all Mediterranean-type ecosystems, are akin to those projected to arise in the second half of the century4. Long-term recovery of this forest is uncertain given an ongoing decline in regional water balance. This dramatic plummet of forest productivity may be a spyglass to the future for other Mediterranean ecosystems.

Equivalent impacts of logging and beaver activities on aboveground carbon stock loss in the southernmost forest on Earth

The conservation of forest landscapes is crucial for global climate strategies, and the forest in Tierra del Fuego, located in Patagonia, represents the southernmost example on Earth. These ecosystems are critical for Chile's roadmap toward carbon neutrality. Unfortunately, these ecosystems have been impacted by logging and beaver activities. Currently, the precise contribution of each driver to forest cover and carbon stock loss remains insufficiently quantified, impeding effective policymaking and the implementation of strategies to safeguard and enhance carbon stocks in these ecosystems. In this study, we conducted an assessment of forest carbon stock loss resulting from both logging and beaver activities in Chilean Tierra del Fuego from 1986 to 2019. While beavers have received significant attention for their substantial contribution to forest cover loss (56.1% forest cover, ≈ 1.4 MtC), our findings suggest that logging has nearly equally contributed to carbon stock depletion (43.8% forest cover, ≈ 1.2 MtC). Consequently, the prevailing focus on beavers has obscured the ongoing logging-induced carbon stock loss. The implications of our study highlight the urgency for comprehensive consideration of both drivers in Chile's climate strategy to fulfill the country's mitigation commitments.

Warming and drought weaken the carbon sink capacity of an endangered paleoendemic temperate rainforest in South America

Measurements of ecosystem carbon (C) fluxes in temperate forests are concentrated in the Northern Hemisphere, leaving the functionally diverse temperate forests in the Southern Hemisphere underrepresented. Here, we report three years (February 2018-January 2021) of C fluxes, studied with eddy-covariance and closed chamber techniques, in an endangered temperate evergreen rainforest of the long-lived paleoendemic South American conifer Fitzroya cupressoides. Using classification and regression trees we analyzed the most relevant drivers and thresholds of daily net ecosystem exchange (NEE) and soil respiration. The annual NEE showed that the forest was a moderate C sink during the period analyzed (-287±38 g C m^-2 year ^-1). We found that the capacity to capture C of the Fitzroya rainforests in the Coastal Range of southern Chile is optimal under cool and rainy conditions in the early austral spring (October-November) and decreases rapidly towards the summer dry season (January-February) and autumn. Although the studied forest type has a narrow geographical coverage, the gross primary productivity measured at the tower was highly representative of Fitzroya and other rainforests in the region. Our results suggest that C fluxes in paleoendemic cool F. cupressoides forests may be negatively affected by the warming and drying predicted by climate change models, reinforcing the importance of maintaining this and other long-term ecological research sites in the Southern Hemisphere.

Ecophysiological responses of Nothofagus obliqua forests to recent climate drying across the Mediterranean-Temperate biome transition in south-central Chile

The forests of south-central Chile are facing a drying climate and a megadrought that started in 2010. This study addressed the physiological responses of five Nothofagus obliqua stands across the Mediterranean-Temperate gradient (35.9 ° -40.3° S) using carbon isotope discrimination (Δ¹³ C) and intrinsic water use efficiency (iWUE) in tree rings during 1967-2017. Moreover, δ¹⁸O was evaluated in the northernmost site to better understand the effects of the megadrought in this drier location. These forests have become more efficient in their use of water. However, trees from the densest stand are discriminating more against ¹³C, probably due to reduced photosynthetic rates associated with increasing competition. The strongest associations between climate and Δ¹³C were found in the northernmost stand, suggesting that warmer and drier conditions could have reduced ¹³C discrimination. Tree growth in this site has not decreased, and δ¹⁸O was negatively related to annual rainfall. However, a shift in this relationship was found since 2007, when both precipitation and δ¹⁸O decreased, while correlations between δ¹⁸O and growth increased. This implies that tree growth and δ¹⁸O are coupled in recent years, but precipitation is not the cause, suggesting that trees probably changed their water source to deeper and more depleted pools. Our research demonstrates that forests are not reducing their growth in central Chile, mainly due to a shift towards the use of deeper water sources. Despite a common climate trend across the gradient, there is a non-uniform response of N. obliqua forests to climate drying, being their response site specific. Keywords: Tree rings, stable isotopes, tree physiology, climate gradient, megadrought, climate change.

Correlation and validity of imputed PaO2/FiO2 and SpO2/FiO2 in patients with invasive mechanical ventilation at 2600m above sea level

OBJECTIVE

To establish the correlation and validity between PaO2/FiO2 obtained on arterial gases versus noninvasive methods (linear, nonlinear, logarithmic imputation of PaO2/FiO2 and SpO2/FiO2) in patients under mechanical ventilation living at high altitude.

DESIGN

Ambispective descriptive multicenter cohort study.

SETTING

Two intensive care units (ICU) from Colombia at 2600m a.s.l.

PATIENTS OR PARTICIPANTS

Consecutive critically ill patients older than 18 years with at least 24h of mechanical ventilation were included from June 2016 to June 2019.

INTERVENTIONS

None.

VARIABLES

Variables analyzed were demographic, physiological messures, laboratory findings, oxygenation index and clinical condition. Nonlinear, linear and logarithmic imputation formulas were used to calculate PaO2 from SpO2, and at the same time the SpO2/FiO2 by severe hypoxemia diagnosis. The intraclass correlation coefficient, area under the ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were calculated.

RESULTS

The correlation between PaO2/FiO2 obtained from arterial gases, PaO2/FiO2 derived from one of the proposed methods (linear, non-linear, and logarithmic formula), and SpO2/FiO2 measured by the intraclass correlation coefficient was high (greater than 0.77, p<0.001). The different imputation methods and SpO2/FiO2 have a similar diagnostic performance in patients with severe hypoxemia (PaO2/FiO2 <150). PaO2/FiO2 linear imputation AUC ROC 0,84 (IC 0.81-0.87, p<0.001), PaO2/FiO2 logarithmic imputation AUC ROC 0.84 (IC 0.80-0.87, p<0.001), PaO2/FiO2 non-linear imputation AUC ROC 0.82 (IC 0.79-0.85, p<0.001), SpO2/FiO2 oximetry AUC ROC 0.84 (IC 0.81-0.87, p<0.001).

CONCLUSIONS

At high altitude, the SaO2/FiO2 ratio and the imputed PaO2/FiO2 ratio have similar diagnostic performance in patients with severe hypoxemia ventilated by various pathological conditions.

Moving towards the ecological intensification of tree plantations

The growing demand for timber and the boom in massive tree-planting programs could mean the spreading of mismanaged tree plantations worldwide. Here, we apply the concept of ecological intensification to forestry systems as a viable biodiversity-focused strategy that could be critical to develop productive, yet sustainable, tree plantations. Tree plantations can be highly productive if tree species are properly combined to complement their ecological functions. Simultaneously considering soil biodiversity and animal-mediated biocontrol will be critical to minimize the reliance on external inputs. Integrating genetic, functional, and demographic diversity across heterogeneous landscapes should improve resilience under climate change. Designing ecologically intensified plantations will mean breaking the timber productivity versus conservation dichotomy and assuring the maintenance of key ecosystem services at safe levels.

Correlation and validity of imputed PaO2/FiO2 and SpO2/FiO2 in patients with invasive mechanical ventilation at 2600m above sea level

OBJECTIVE

To establish the correlation and validity between PaO2/FiO2 obtained on arterial gases versus noninvasive methods (linear, nonlinear, logarithmic imputation of PaO2/FiO2 and SpO2/FiO2) in patients under mechanical ventilation living at high altitude.

DESIGN

Ambispective descriptive multicenter cohort study.

SETTING

Two intensive care units (ICU) from Colombia at 2600m a.s.l.

PATIENTS OR PARTICIPANTS

Consecutive critically ill patients older than 18 years with at least 24h of mechanical ventilation were included from June 2016 to June 2019.

INTERVENTIONS

None.

VARIABLES

Variables analyzed were demographic, physiological messures, laboratory findings, oxygenation index and clinical condition. Nonlinear, linear and logarithmic imputation formulas were used to calculate PaO2 from SpO2, and at the same time the SpO2/FiO2 by severe hypoxemia diagnosis. The intraclass correlation coefficient, area under the ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were calculated.

RESULTS

The correlation between PaO2/FiO2 obtained from arterial gases, PaO2/FiO2 derived from one of the proposed methods (linear, non-linear, and logarithmic formula), and SpO2/FiO2 measured by the intraclass correlation coefficient was high (greater than 0.77, p<0.001). The different imputation methods and SpO2/FiO2 have a similar diagnostic performance in patients with severe hypoxemia (PaO2/FiO2 <150). PaO2/FiO2 linear imputation AUC ROC 0,84 (IC 0.81-0.87, p<0.001), PaO2/FiO2 logarithmic imputation AUC ROC 0.84 (IC 0.80-0.87, p<0.001), PaO2/FiO2 non-linear imputation AUC ROC 0.82 (IC 0.79-0.85, p<0.001), SpO2/FiO2 oximetry AUC ROC 0.84 (IC 0.81-0.87, p<0.001).

CONCLUSIONS

At high altitude, the SaO2/FiO2 ratio and the imputed PaO2/FiO2 ratio have similar diagnostic performance in patients with severe hypoxemia ventilated by various pathological conditions.

Changes in REVEAL risk score in patients with pulmonary arterial hypertension treated with macitentan in clinical practice: results from the PRACMA study

Background

Macitentan is a dual endothelin receptor antagonist indicated for the long-term treatment of pulmonary arterial hypertension (PAH). We evaluated the change over time in REVEAL risk score in incident and prevalent patients receiving macitentan for the first time.

Methods

Retrospective, observational study including adult patients with idiopathic/heritable PAH or PAH associated with connective tissue disorders or congenital heart disease treated with macitentan for ≥6-month follow-up in Spain. The REVEAL risk score and risk strata were computed at the start of macitentan and after ≥6-month in patients with ≥7 out of 12 valid REVEAL components.

Results

Overall, 81 patients (57 for the REVEAL score) were analysed, 77.8% women. The mean age was 57.2 years and 50.6% of patients had idiopathic/heritable PAH. Prevalent patients were 59.3 and 40.7% were incident. Main therapies for PAH included macitentan monotherapy (42.0%) and macitentan in combination with phosphodiesterase type 5 inhibitor (44.4%). With a median time of macitentan treatment of 10.5 months, the mean REVEAL score was 8.7 points at baseline and was 7.2 points after ≥6-month follow-up. The mean change (95% CI) in REVEAL risk score was − 1.4 (− 2.0, − 0.9) points (p < 0.0001), being − 1.8 (− 3.0, − 0.7) points (p = 0.0040) and − 1.2 (− 1.8, − 0.5) points (p = 0.0010), in incident and prevalent patients, respectively. The reduction was also significant by risk stratum (36.8% of patients in the high-very high risk strata at baseline versus 14.0% after ≥6-month, p < 0.05) and therapy group. The REVEAL components that significantly improved were WHO functional class (FC) (63.9% FC III at macitentan initiation and 23.6% after ≥6-month, p < 0.0001), 6-min walk test (mean change: 41.8 m, p < 0.01), brain natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) (mean change of − 157.6 pg/mL and − 530.0 pg/mL, respectively, p < 0.05 both), and pulmonary vascular resistance (PVR) (mean change: − 3.4 WU, p < 0.01).

Conclusions

In this study, treatment with macitentan improved the REVEAL risk strata and score in both incident and prevalent PAH patients, and in all patients regardless of the therapy strategy. Macitentan significantly improved some of REVEAL components including WHO FC, BNP/NT-proBNP, PVR, and 6-min walk test after at least 6-month follow-up.

Low Growth Sensitivity and Fast Replenishment of Non-structural Carbohydrates in a Long-Lived Endangered Conifer After Drought

There is an ongoing debate on whether a drought induced carbohydrate limitation (source limitation) or a direct effect of water shortage (sink limitation) limit growth under drought. In this study, we investigated the effects of the two driest summers recorded in southern Chile in the last seven decades, on the growth and non-structural carbohydrates (NSC) concentrations of the slow-growing conifer Fitzroya cupressoides. Specifically, we studied the seasonal variation of NSC in saplings and adults one and two years after the occurrence of a 2 year-summer drought at two sites of contrasting precipitation and productivity (mesic-productive vs. rainy-less productive). We also evaluated radial growth before, during and after the drought, and predicted that drought could have reduced growth. If drought caused C source limitation, we expected that NSCs will be lower during the first than the second year after drought. Conversely, similar NSC concentrations between years or higher NSC concentrations in the first year would be supportive of sink limitation. Also, due to the lower biomass of saplings compared with adults, we expected that saplings should experience stronger seasonal NSC remobilization than adults. We confirmed this last expectation. Moreover, we found no significant growth reduction during drought in the rainy site and a slightly significant growth reduction at the mesic site for both saplings and adults. Across organs and in both sites and age classes, NSC, starch, and sugar concentrations were generally higher in the first than in the second year following drought, while NSC seasonal remobilization was generally lower. Higher NSC concentrations along with lower seasonal NSC remobilization during the first post-drought year are supportive of sink limitation. However, as these results were found at both sites while growth decreased slightly and just at the mesic site, limited growth only is unlikely to have caused NSC accumulation. Rather, these results suggest that the post-drought dynamics of carbohydrate storage are partly decoupled from the growth dynamics, and that the rebuild of C reserves after drought may be a priority in this species.

Short-term mortality risk score for de novo acute heart failure (ESSIC-FEHF)

BACKGROUND

Different variables are playing a role in prognosis of acute heart failure.

OBJECTIVES

Our purpose was to create and validate a risk score to predict mortality in patients with a first episode of acute heart failure during the first 2 months after the first hospitalization.

DESIGN

This was a prospective cohort study.

PARTICIPANTS

We recruited patients diagnosed with a first episode of acute heart failure.

MAIN MEASURES

We collected data on sociodemographic characteristics; medical history; symptoms; precipitating factors; signs and symptoms of congestion; echocardiographic parameters; aetiology; vital signs and laboratory findings; and response to initial treatment (yes/no). A Cox proportional hazard regression model was built with mortality during the first 2 months after the index episode as the dependent variable. A risk score is presented.

KEY RESULTS

The mortality rate during the first 2 months after a first episode of heart failure was 5%. Age, systolic blood pressure, serum sodium, ejection fraction and blood urea nitrogen were selected in the internal validation, as was right ventricular failure. A risk score was developed. Both the model and the score showed good discrimination and calibration properties when applied to an independent cohort.

CONCLUSIONS

Our ESSIC-FEHF risk score showed excellent properties in the derivation cohort and also in a cohort from a different time period. This score is expected to help decision making in patients diagnosed with heart failure for the first time.

Constraints on Lorentz Invariance Violation from HAWC Observations of Gamma Rays above 100 TeV

Because of the high energies and long distances to the sources, astrophysical observations provide a unique opportunity to test possible signatures of Lorentz invariance violation (LIV). Superluminal LIV enables the decay of photons at high energy. The high altitude water Cherenkov (HAWC) observatory is among the most sensitive gamma-ray instruments currently operating above 10 TeV. HAWC finds evidence of 100 TeV photon emission from at least four astrophysical sources. These observations exclude, for the strongest of the limits set, the LIV energy scale to 2.2×10^{31}  eV, over 1800 times the Planck energy and an improvement of 1 to 2 orders of magnitude over previous limits.

Multiple Galactic Sources with Emission Above 56 TeV Detected by HAWC

We present the first catalog of gamma-ray sources emitting above 56 and 100 TeV with data from the High Altitude Water Cherenkov Observatory, a wide field-of-view observatory capable of detecting gamma rays up to a few hundred TeV. Nine sources are observed above 56 TeV, all of which are likely galactic in origin. Three sources continue emitting past 100 TeV, making this the highest-energy gamma-ray source catalog to date. We report the integral flux of each of these objects. We also report spectra for three highest-energy sources and discuss the possibility that they are PeVatrons.

Multidecadal environmental pollution in a mega-industrial area in central Chile registered by tree rings

One of the most polluted areas in Chile is the Ventanas Industrial Area (VIA; 32.74°S / 71.48°W), which started in 1958 and today comprises around 16 industries in an area of ca. 4 km². A lack of consistent long-term instrumental records precludes assessing the history of contamination in the area and also limits the evaluation of mitigation actions taken since the late 1980s. Here, we use dendrochemistry as an environmental proxy to analyze environmental changes over several decades at the VIA. We present chemical measurements of tree rings from planted, exotic Cupressus macrocarpa growing near the VIA with 4-year resolution over a period of 52 years (1960-2011). These data provide unprecedented information on regional anthropogenic pollution and are compared with a tree-ring elemental record of 48 years (1964-2011) from the Isla Negra (INE) control site not exposed to VIA emissions. For the 48 years of overlap between both sites, higher concentrations of Zn, V, Co, Cd, Ag, Fe, Cr, and Al were especially registered after the year 2000 at VIA compared to INE for the periods under study. Concentrations of Pb, Cu, As, Fe, Mo, Cr, and Zn increased through time, particularly over the period 1980-1990. Decontamination plans activated in 1992 appear to have had a positive effect on the amount of some elements, but the chemical concentration in the tree rings suggest continued accumulation of pollutants in the environment. Only after several years of implementation of the mitigation measures have some elements tended to decrease in concentration, especially at the end of the evaluated period. Dendrochemistry is a useful tool to provide a long-term perspective of the dynamics of trace metal pollution and represents a powerful approach to monitor air quality variability to extend the instrumental records back in time.

Evaluation of VIDAS® Listeria species Xpress (LSX) Immunoassay Method for the Detection of Listeria species in Foods: Collaborative Study

In a multilaboratory study, the effectiveness of an alternative method for rapid screening of Listeria species compared to traditional reference methods was demonstrated in a variety of food products. A collaborative study was conducted to compare the VIDAS® Listeria species Xpress (LSX) method and the standard cultural methods for the detection of Listeria species in foods. Six food types were tested: vanilla ice cream, cheddar cheese, raw ground beef, frozen green beans, deli turkey, and cooked shrimp. Each food, inoculated with a different Listeria strain at two levels and uninoculated test portions, was analyzed by each method. A total of 15 laboratories representing government and industry participated. In this study 1134 tests were analyzed in the statistical analysis. There were 490 positives by the VIDAS LSX method using the sample boiling step, 483 positives by the VIDAS LSX method using the Heat and Go system, and 439 positives by the standard culture methods. Overall, the Chi-square result for the VIDAS LSX method with boiling for all foods was 7.25, indicating a significant statistical difference between the VIDAS method and the standard methods at the 5% confidence. For the VIDAS LSX method with the Heat and Go system, the Chi-square result for all foods was 5.37, indicating a significant statistical difference between the VIDAS LSX assay with the Heat and Go system and the standard methods at the 5% level of significance. In both cases, the VIDAS method was more sensitive than the standard methods. The LSX method detects Listeria species in foods with negative or presumptive positive results in a minimum of 30 h compared to at least 5 days for the cultural methods. Based on the results of this collaborative study, it is recommended that the VIDAS LSX method be adopted as an AOAC Official MethodSM for the detection of Listeria species in dairy products, vegetables, seafood, raw meats and poultry, and processed meats and poultry.

Natural clays with an inherent uranium component that nevertheless sequester uranium from contaminated water

Clays present a cost effective and sustainable method for removing uranium and heavy metals from drinking water because of their cation exchange capabilities. However, managing muddy suspensions is problematic; therefore, clay pellets as presented in this article are a promising alternative. Three standard clays and two regional clays were evaluated for sorption, both in powder form and in pellet structure for comparison. The objective was to evaluate individual sorption processes and assess the effect on uranium sorption due to the process of altering the clay powder to produce pellets. The sorption capacity of the pellets is sufficiently large to not only sorb the intrinsic non-bonded uranium but to continue to sorb uranium from contaminated water. Furthermore, the uranyl cation was also removed preferentially in the presence of Pb²⁺ and Cd²⁺ heavy metal cations, hydronium ions, and more importantly the naturally occurring cations, Na¹⁺, Ca²⁺, and Mg²⁺ that occur in abundant concentrations. Clay pellets as well as powders reduced uranium concentrations, and in extreme cases from 450 ppb, 15 times the Environmental Protection Agency maximum contaminant level to non-detectable limits. Clay pellets are excellent candidates for the safe and manageable removal of uranium and heavy metals to produce potable water.

Hybrid Systems for the Generation of Nonclassical Mechanical States via Quadratic Interactions

We present a method to implement two-phonon interactions between mechanical resonators and spin qubits in hybrid setups, and show that these systems can be applied for the generation of nonclassical mechanical states even in the presence of dissipation. In particular, we demonstrate that the implementation of a two-phonon Jaynes-Cummings Hamiltonian under coherent driving of the qubit yields a dissipative phase transition with similarities to the one predicted in the model of the degenerate parametric oscillator: beyond a certain threshold in the driving amplitude, the driven-dissipative system sustains a mixed steady state consisting of a "jumping cat," i.e., a cat state undergoing random jumps between two phases. We consider realistic setups and show that, in samples within reach of current technology, the system features nonclassical transient states, characterized by a negative Wigner function, that persist during timescales of fractions of a second.

Tree rings reveal globally coherent signature of cosmogenic radiocarbon events in 774 and 993 CE

Though tree-ring chronologies are annually resolved, their dating has never been independently validated at the global scale. Moreover, it is unknown if atmospheric radiocarbon enrichment events of cosmogenic origin leave spatiotemporally consistent fingerprints. Here we measure the ¹⁴C content in 484 individual tree rings formed in the periods 770–780 and 990–1000 CE. Distinct ¹⁴C excursions starting in the boreal summer of 774 and the boreal spring of 993 ensure the precise dating of 44 tree-ring records from five continents. We also identify a meridional decline of 11-year mean atmospheric radiocarbon concentrations across both hemispheres. Corroborated by historical eye-witness accounts of red auroras, our results suggest a global exposure to strong solar proton radiation. To improve understanding of the return frequency and intensity of past cosmic events, which is particularly important for assessing the potential threat of space weather on our society, further annually resolved ¹⁴C measurements are needed.

Despite their extensive use, the absolute dating of tree-ring chronologies has not hitherto been independently validated at the global scale. Here, the identification of distinct ¹⁴C excursions in 484 individual tree rings, enable the authors to confirm the dating of 44 dendrochronologies from five continents.

Partition coefficients of methylated DNA bases obtained from free energy calculations with molecular electron density derived atomic charges

Partition coefficients serve in various areas as pharmacology and environmental sciences to predict the hydrophobicity of different substances. Recently, they have also been used to address the accuracy of force fields for various organic compounds and specifically the methylated DNA bases. In this study, atomic charges were derived by different partitioning methods (Hirshfeld and Minimal Basis Iterative Stockholder) directly from the electron density obtained by electronic structure calculations in a vacuum, with an implicit solvation model or with explicit solvation taking the dynamics of the solute and the solvent into account. To test the ability of these charges to describe electrostatic interactions in force fields for condensed phases, the original atomic charges of the AMBER99 force field were replaced with the new atomic charges and combined with different solvent models to obtain the hydration and chloroform solvation free energies by molecular dynamics simulations. Chloroform-water partition coefficients derived from the obtained free energies were compared to experimental and previously reported values obtained with the GAFF or the AMBER-99 force field. The results show that good agreement with experimental data is obtained when the polarization of the electron density by the solvent has been taken into account, and when the energy needed to polarize the electron density of the solute has been considered in the transfer free energy. These results were further confirmed by hydration free energies of polar and aromatic amino acid side chain analogs. Comparison of the two partitioning methods, Hirshfeld-I and Minimal Basis Iterative Stockholder (MBIS), revealed some deficiencies in the Hirshfeld-I method related to the unstable isolated anionic nitrogen pro-atom used in the method. Hydration free energies and partitioning coefficients obtained with atomic charges from the MBIS partitioning method accounting for polarization by the implicit solvation model are in good agreement with the experimental values. © 2018 Wiley Periodicals, Inc.

Extended gamma-ray sources around pulsars constrain the origin of the positron flux at Earth

The unexpectedly high flux of cosmic-ray positrons detected at Earth may originate from nearby astrophysical sources, dark matter, or unknown processes of cosmic-ray secondary production. We report the detection, using the High-Altitude Water Cherenkov Observatory (HAWC), of extended tera-electron volt gamma-ray emission coincident with the locations of two nearby middle-aged pulsars (Geminga and PSR B0656+14). The HAWC observations demonstrate that these pulsars are indeed local sources of accelerated leptons, but the measured tera-electron volt emission profile constrains the diffusion of particles away from these sources to be much slower than previously assumed. We demonstrate that the leptons emitted by these objects are therefore unlikely to be the origin of the excess positrons, which may have a more exotic origin.

Correction: Lung and heart-lung transplantation in pulmonary arterial hypertension

[This corrects the article DOI: 10.1371/journal.pone.0187811.].

Kca3.1 Activation Via P2y2 Purinergic Receptors Promotes Human Ovarian Cancer Cell (Skov-3) Migration

Disorders in cell signaling mediated by ATP or histamine, activating specific membrane receptors, have been frequently associated with tumorigenesis. Among the elements of response to purinergic (and histaminergic) signaling, ion channel activation controls essential cellular processes in cancer, such as cell proliferation, motility, and death. Here, we studied the effects that ATP had on electrical properties of human ovarian adenocarcinoma cells named SKOV-3. ATP caused increase in intracellular Ca²⁺ concentration ([Ca²⁺]_i) and, concurrently, it evoked a complex electrical response with a conspicuous outward component. This current was generated through P2Y₂ receptor activation and opening of K⁺ channels, K_Ca3.1, as indicated by electrophysiological and pharmacological analysis, as well as by immunodetection and specific silencing of P2Y₂ or K_Ca3.1 gene by esiRNA transfection. Low µM ATP concentration increased SKOV-3 cell migration, which was strongly inhibited by K_Ca3.1 channel blockers and by esiRNA-generated P2Y₂ or K_Ca3.1 downregulation. Finally, in human ovarian tumors, the P2Y₂ and K_Ca3.1 proteins are expressed and co-localized in neoplastic cells. Thus, stimulation of P2Y₂ receptors expressed in SKOV-3 cells promotes motility through K_Ca3.1 activation. Since P2Y₂ and K_Ca3.1 are co-expressed in primary tumors, our findings suggest that they may play a role in cancer progression.

Effects of grain level on lamb performance, ruminal metabolism and leptin mRNA expression in perirenal adipose tissue

The effects of four different grain composition diets of finishing lambs on lamb performance, dry matter (DM) digestibility, rumen fermentation and leptin mRNA expression were evaluated. Thirty-two Pelibuey lambs (25.35 ± 4.73 kg bodyweight) were used in a completely randomised experiment in which lambs were fed diets that contained 30%, 45%, 60% or 75% grain (DM basis). The results indicated that increasing the grain level improved the average daily weight gain, hot carcass weight, DM digestibility and feed conversion linearly (P < 0.01); however, feed intake was not affected. Ruminal pH decreased linearly as the grain content was increased (P < 0.01). Ruminal propionate concentration increased and acetate concentration declined with increased grain content (P < 0.01). Leptin mRNA expression in perirenal adipose tissue increased linearly (P < 0.05) as grain content increased. Based on these results, we conclude that increasing grain level in the diets of finishing feedlot lambs improved weight gain and feed efficiency; however, because weight gain and feed efficiency were similar at the higher grain levels, our data suggest including 60% grain in lamb finishing rations.

[Rupture of a superior mesenteric artery aneurysm in pediatric age: case report and literature review]

INTRODUCTION

Splanchnic artery aneurysms are rare in children. High mortality from rupture justifies its treatment, with various therapeutic options among which stand out surgery and recently, endovascular treatment.

CASE REPORT

A 11 year old girl presented with abdominal pain and sudden drop in hematocrit. The urgent abdominal CT angiography showed a saccular aneurysm of the superior mesenteric artery (SMA) at 4 cm from the ostium with dissection and active bleeding. A selective angiography was performed which confirmed the dissection. A self-expanding stent was placed in the main trunk of the SMA and a transcatheter coil and onyx embolization of the aneurysm was performed. The control angiogram showed no evidence of residual perfusion of the false lumen and demonstrated proper vascularization of the distal jejunum-ileal branches. Dual antiplatelet therapy with aspirin and dipyridamole was begun. After 24 months of follow-up the patient is asymptomatic.

COMMENTS

Endovascular treatment of a SMA aneurysm is effective in the pediatric patient, even in emergency situations.

Vegetación y paisaje alrededor del lago de Montcortès (Prepirineos catalanes) como instrumento para el estudio paleoecológico de los sedimentos lacustres

El lago de Montcortès (42º 19′ N, 0º 59′ E; 1027 m altitud) posee sedimentos con laminaciones anuales, ideales para estudios paleoecológicos de alta resolución. Para el análisis palinológico de estos sedimentos, es necesario conocer en detalle la vegetación local, como fuente del polen sedimentario. El objetivo de este estudio es reconocer y cartografiar los tipos de vegetación presentes alrededor del lago, para lo cual se delimitó un área rectangular de unas 48 ha. Del estudio florístico de este espacio resultó un catálogo de 534 especies, que sirvió de base para el análisis de vegetación. Para ello, se llevaron a cabo 42 inventarios fitosociológicos, que se utilizaron para elaborar una síntesis del paisaje vegetal mediante cartografía digital. Como resultado, se obtuvieron 52 unidades de vegetación, expresión concreta de los hábitats CORINE definidos en la lista de los hábitats de Cataluña. Cada una de estas unidades se describió con criterios florísticos, fisionómicos, fitogeográficos, ambientales y de uso humano. La siguiente etapa consistirá en el estudio palinológico de las especies más representativas de los tipos de vegetación y hábitats establecidos aquí, con el fin de optimizar las interpretaciones paleoecológicas futuras.

Performance of the Sysmex UF1000i system in screening for significant bacteriuria before quantitative culture of aerobic/facultative fast-growth bacteria in a reference hospital

OBJECTIVE

To evaluate the performance of the Sysmex UF1000i automatic urine screening system in the quantitative culture of fast-growth aerobic/facultative bacteria.

METHODS AND RESULTS

A standard procedure was used to recover fast-growth aerobic/facultative micro-organisms in 1225 samples, applying (Sysmex(®)) flow cytometry for parallel bacteria and leucocyte counts. According to the area under the receiver operating characteristic curve, the optimal cut-off values to detect bacteriuria >10(5) colony forming units (CFU) ml(-1) were 690/μl for bacteria and 38/μl for leucocytes (sensitivity, 92%; specificity, 65%; positive predictive value [PPV], 39%; and negative predictive value [NPV], 97%). The use of a single cut-off point of 150 bacteria μl(-1) to detect significant bacteriuria of >10(5) CFU ml(-1) or of ≥10(4) CFU ml(-1) plus leucocyturia obtained similar results (sensitivity, 89%; specificity, 54%; PPV, 31%; and NPV, 96%) and allowed 45.7% of the samples to be rapidly excluded.

CONCLUSIONS

The Sysmex UF1000i system can be adapted for bacteriuria screening by the use of an appropriate cut-off point.

SIGNIFICANCE AND IMPACT OF THE STUDY

This screening system significantly reduces the workload and produces very few false positives and negatives.

Garlic derivatives (PTS and PTS-O) differently affect the ecology of swine faecal microbiota in vitro

A number of in vitro experiments were designed to evaluate the effects of two different industrial products, namely PROALLIUM-S-DMC and PROALLIUM-SO-DMC (DMC Research Center, Granada, Spain), obtained from garlic (Allium sativum) on the faecal microbiota of pigs. The effects of three different concentrations (50, 200 and 400 ppm) of the active compounds (PTS and PTS-O, respectively) from both industrial products on the gastrointestinal microbiota of pigs were tested. Growth medium without any additive (0 ppm) was used as control. Predominant bacterial groups (total aerobes, total anaerobes, lactobacilli, bifidobacteria, coliforms, enterobacteria, bacteroides and clostridia) were studied. Results showed that both PTS and PTS-O have significant (P<0.01) antimicrobial activity against every group studied, although enterobacteria and coliforms were the most affected populations (P<0.01). Time kill curves for Escherichia coli and Salmonella typhimurium, two common pathogens of pigs, showed that both compounds had a bactericidal effect against these strains. For the bacterial groups here studied, the antimicrobial effect of PTS-O was significantly (P<0.001) stronger than that of PTS. Trials in vivo are in course to study the potential use of these products as alternatives to antibiotics in pig feeds.

Vocal Pathologies of Difficult Diagnosis

The objective of this study was to review four vocal pathologies difficult to diagnose (vocal sulci, submucosal cysts, pseudocysts, and mucosal bridges) seen in the Principe de Asturias University Hospital Voice Unit (Alcalá de Henares, Madrid, Spain) over a 9-year period. This study was to show the prevalence of these pathologies out of the total number of benign vocal pathologies, basing our findings on clinical and stroboscopic criteria; and to analyze the stroboscopic-surgical correlation of the series over the last 3 1/2 years. This study was a retrospective review of the stroboscopies carried out between 1993 and 2002, of the suspected diagnoses offered by three ENT specialists. The data were based on the video archives of the unit and surgical notes. We reviewed 4206 stroboscopies, 189 (4.5%) corresponded to new cases. Within this group, we found the following distribution: 48% of vocal sulci, 42% of submucosal cysts, 10% of pseudocysts, and 0% of mucosal bridges. Seventy-nine percent showed unilateral pathology. The sulci showed the highest percentage of bilaterality (33%). The stroboscopic-surgical correlation (1999-2002) was positive in 69% of the sulci, 78% of the cysts, and 100% of the pseudocysts. In our series, 4.5% of the stroboscopies were performed on these groups of difficult diagnosis. For these pathologies, the stroboscopy is the exploratory method that offers more information and that allows us to obtain an optimal correlation between diagnostic suspicion and surgical evidence.

Prevalence and management of potential candidates for simultaneous pancreas-kidney transplantation in a provincial setting

INTRODUCTION

Simultaneous pancreas-kidney (SPK) transplantation is the best therapeutic option for correctly selected diabetic patients with advanced chronic kidney disease (CKD).

OBJECTIVES

The objectives of this study were to quantify in a Spanish province the prevalence and incidence of type 1 and 2 diabetics with stage IV-V CKD who are potential candidates for SPK, and to analyze the selection for SPK in clinical practice.

MATERIALS AND METHODS

All patients with diabetic neuropathy (DN) in predialysis, hemodialysis, or peritoneal dialysis (PD) in our transplantation referral area (population, 1.8 million; data collection ended December 7, 2005) were examined for basic SPK criteria (NTO 2005 Consensus). A new assessment was performed 9 months later, including new possible recipients, and patients were classified as: follows in study, excluded after study, added to SPK waiting list, or SPK-transplanted.

RESULTS

In 2005, there were 1371 patients in dialysis or predialysis, including 179 (13%) with DN (41 type 1 and 138 type 2 DM); only 16 of these patients (8.9% of DN patients), 8.9 per million population (PMP), met the basic criteria for SPK transplantation. There were 68 with DN in predialysis, including 8 (11.7%) possible SPK candidates; 7 with DN in PD, no candidates for SPK; and 104 patients with DN in hemodialysis, including 8 (7.2%) SPK candidates. After 9 months, 7 new potential candidates were identified (incidence of 5.1 PMP/y). Of 23 possible candidates, 3 refused SPK, 7 awaited completion of study, 8 were excluded after study, 1 was on the SPK waiting list, and 7 underwent SPK transplantation.

CONCLUSIONS

In our setting, approximately 9% of DN patients with stage IV-V CKD were potential SPK candidates in 2005 and 2006. After completion of studies, less than half were eventually included on the waiting list, generating an effective demand for SPK of 2-4 new patients PMP/y.