Epidemiological aspects, clinical management and short-term outcomes in elderly patients diagnosed with acute heart failure in the emergency department in Spain: results of the EDEN-34 study

OBJECTIVE

To estimate the incidence of acute heart failure (AHF) diagnosis in elderly patients in emergency departments (ED), diagnostic confirmation in hospitalized patients, and short-term adverse events.

METHODS

All patients aged ≥65 years attended in 52 Spanish EDs during 1 week were included and those diagnosed with AHF were selected. In hospitalized patients, those diagnosed with AHF at discharge were collected. As adverse events, in-hospital and 30-day mortality, and combined adverse event (death or hospitalization) at 30 days post-discharge were collected. Adjusted odds ratios (OR) for association of demographic variables, baseline status and constants at ED arrival with mortality and 30-day post-discharge adverse event were calculated.

RESULTS

We included 1,155 patients with AHF (annual incidence: 26.5 per 1000 inhabitants ≥65 years, 95% CI: 25.0-28.1). In 86% the diagnosis of AHF was known at discharge. Overall 30-day mortality was 10.7% and in-hospital mortality was 7.9%, and the combined event in 15.6%. In-hospital and 30-day mortality was associated with arterial hypotension (adjusted OR: 74.0, 95% CI: 5.39-1015. and 42.6, 3.74-485, respectively and hypoxemia (2.14, 1.27-3.61; and 1.87, 1.19-2.93) on arrival at the ED and requiring assistance with ambulation (2.24, 1.04-4.83; and 2.48, 1.27-4.86) and age (per 10-year increment; 1.54, 1.04-2.29; and 1.60, 1.13-2.28). The combined post-discharge adverse event was not associated with any characteristic.

CONCLUSIONS

AHF is a frequent diagnosis in elderly patients consulting in the ED. The functional impairment, age, hypotension and hypoxemia are the factors most associated with mortality.

Recommendations for the prevention of healthcare-associated infections in nursing homes

Nursing homes (NH) conceptually should look as much like a home as possible. However NH have unquestionable similarities with a nosocomium as they are places where many patients with underlying diseases and comorbidities accumulate. There is evidence of transmission of microorganisms between residents and between residents and caregivers. We have not found any recommendations specifically aimed at the prevention of nosocomial infections in NH by the major Public Health Agencies and, therefore, the Health Sciences Foundation (Fundación de Ciencias de la Salud) has convened a series of experts and 14 Spanish scientific societies to discuss recommendations that could guide NH personnel in establishing written programs for the control and reduction of these infections. The present document is the result of these deliberations and contains suggestions for establishing such control programs on a voluntary and flexible basis in NH. We also hope that the document can help the health authorities to encourage this control activity in the different territorial areas of Spain. In our opinion, it is necessary to draw up a written plan and establish the figure of a coordinator or person responsible for implementing these projects. The document includes measures to be implemented and ways of quantifying the reality of different problems and of monitoring the impact of the measures established.

Contribution of viral and bacterial infections to senescence and immunosenescence

Cellular senescence is a key biological process characterized by irreversible cell cycle arrest. The accumulation of senescent cells creates a pro-inflammatory environment that can negatively affect tissue functions and may promote the development of aging-related diseases. Typical biomarkers related to senescence include senescence-associated β-galactosidase activity, histone H2A.X phosphorylation at serine139 (γH2A.X), and senescence-associated heterochromatin foci (SAHF) with heterochromatin protein 1γ (HP-1γ protein) Moreover, immune cells undergoing senescence, which is known as immunosenescence, can affect innate and adaptative immune functions and may elicit detrimental effects over the host's susceptibility to infectious diseases. Although associations between senescence and pathogens have been reported, clear links between both, and the related molecular mechanisms involved remain to be determined. Furthermore, it remains to be determined whether infections effectively induce senescence, the impact of senescence and immunosenescence over infections, or if both events coincidently share common molecular markers, such as γH2A.X and p53. Here, we review and discuss the most recent reports that describe cellular hallmarks and biomarkers related to senescence in immune and non-immune cells in the context of infections, seeking to better understand their relationships. Related literature was searched in Pubmed and Google Scholar databases with search terms related to the sections and subsections of this review.

Modified Chevrel technique for abdominal closure in critically ill patients with abdominal hypertension and limited options for closure

Abdominal compartment syndrome is a potentially life-threatening condition seen in critically ill patients, and most often caused by acute pancreatitis, postoperative abdominal vascular thrombosis or mesenteric ischemia. A decompressive laparotomy is sometimes required, often resulting in hernias, and subsequent definitive wall closure is challenging.

AIM

This study aims to describe short term results after a modified Chevrel technique for midline laparotomies in patients witch abdominal hypertension.

MATERIALS AND METHODS

We performed a modified Chevrel as an abdominal closure technique in 9 patients between January 2016 and January 2022. All patients presented varying degrees of abdominal hypertension.

RESULTS

Nine patients were treated with new technique (6 male and 3 female), all of whom had conditions that precluded unfolding the contralateral side as a means for closure. The reasons for this were diverse, including presence of ileostomies, intraabdominal drainages, Kher tubes or an inverted T scar from previous transplant. The use of mesh was initially dismissed in 8 of the patients (88,9%) because they required subsequent abdominal surgeries or active infection. None of the patients developed a hernia, although two died 6 months after the procedure. Only one patient developed bulging. A decrease in intrabdominal pressure was achieved in all patients.

CONCLUSION

The modified Chevrel technique can be used as a closure option for midline laparotomies in cases where the entire abdominal wall cannot be used.

Aging envisage imbalance of the periodontium: A keystone in oral disease and systemic health

Aging is a gradual and progressive deterioration of integrity across multiple organ systems that negatively affects gingival wound healing. The cellular responses associated with wound healing, such as collagen synthesis, cell migration, proliferation, and collagen contraction, have been shown to be lower in gingival fibroblasts (the most abundant cells from the connective gingival tissue) in aged donors than young donors. Cellular senescence is one of the hallmarks of aging, which is characterized by the acquisition of a senescence-associated secretory phenotype that is characterized by the release of pro-inflammatory cytokines, chemokines, growth factors, and proteases which have been implicated in the recruitment of immune cells such as neutrophils, T cells and monocytes. Moreover, during aging, macrophages show altered acquisition of functional phenotypes in response to the tissue microenvironment. Thus, inflammatory and resolution macrophage-mediated processes are impaired, impacting the progression of periodontal disease. Interestingly, salivary antimicrobial peptides, such as histatins, which are involved in various functions, such as antifungal, bactericidal, enamel-protecting, angiogenesis, and re-epithelization, have been shown to fluctuate with aging. Several studies have associated the presence of Porphyromonas gingivalis, a key pathogen related to periodontitis and apical periodontitis, with the progression of Alzheimer's disease, as well as gut, esophageal, and gastric cancers. Moreover, herpes simplex virus types 1 and 2 have been associated with the severity of periodontal disease, cardiovascular complications, and nervous system-related pathologies. This review encompasses the effects of aging on periodontal tissues, how P. gingivalis and HSV infections could favor periodontitis and their relationship with other pathologies.

Lurbinectedin, a selective inhibitor of oncogenic transcription, in patients with pretreated germline BRCA1/2 metastatic breast cancer: results from a phase II basket study

BACKGROUND

Lurbinectedin, a selective inhibitor of oncogenic transcription, has shown preclinical antitumor activity against homologous recombination repair-deficient models and preliminary clinical activity in BRCA1/2 breast cancer.

PATIENTS AND METHODS

This phase II basket multitumor trial (NCT02454972) evaluated lurbinectedin 3.2 mg/m² 1-h intravenous infusion every 3 weeks in a cohort of 21 patients with pretreated germline BRCA1/2 breast cancer. Patients with any hormone receptor and human epidermal growth factor receptor 2 status were enrolled. The primary efficacy endpoint was overall response rate (ORR) according to RECIST v1.1. Secondary endpoints included duration of response (DoR), progression-free survival (PFS), overall survival (OS) and safety.

RESULTS

Confirmed partial response (PR) was observed in six patients [ORR = 28.6%; 95% confidence interval (CI) 11.3% to 52.2%] who had received a median of two prior advanced chemotherapy lines. Lurbinectedin was active in both BRCA mutations: four PRs in 11 patients (36.4%) with BRCA2 and two PRs in 10 patients (20.0%) with BRCA1. Median DoR was 8.6 months, median PFS was 4.1 months and median OS was 16.1 months. Stable disease (SD) was observed in 10 patients (47.6%), including 3 with unconfirmed response in a subsequent tumor assessment [ORR unconfirmed = 42.9% (95% CI 21.8% to 66.0%)]. Clinical benefit rate (PR + SD ≥ 4 months) was 76.2% (95% CI 52.8% to 91.8%). No objective response was observed among patients who had received prior poly (ADP-ribose) polymerase inhibitors. The most common treatment-related adverse events (AEs) were nausea (61.9%), fatigue (38.1%) and vomiting (23.8%). These AEs were mostly grade 1/2. The most common grade 3/4 toxicity was neutropenia (42.9%: grade 4, 23.8%: with no febrile neutropenia).

CONCLUSIONS

This phase II study met its primary endpoint and showed activity of lurbinectedin in germline BRCA1/2 breast cancer. Lurbinectedin showed a predictable and manageable safety profile. Considering the exploratory aim of this trial as well as previous results in other phase II studies, further development of lurbinectedin in this indication is warranted.

Study of the relationship between regional cerebral saturation and pCO2 changes during mechanical ventilation to evaluate modifications in cerebral perfusion in a newborn piglet model

Near-infrared spectroscopy (NIRS) could be a useful continuous, non-invasive technique for monitoring the effect of partial pressure of carbon dioxide (PaCO₂) fluctuations in the cerebral circulation during ventilation. The aim of this study was to examine the efficacy of NIRS to detect acute changes in cerebral blood flow following PaCO₂ fluctuations after confirming the autoregulation physiology in piglets. Fourteen piglets (<72 h of life) were studied. Mean arterial blood pressure, oxygen saturation, pH, glycemia, hemoglobin, electrolytes, and temperature were monitored. Eight animals were used to evaluate brain autoregulation, assessing superior cava vein Doppler as a proxy of cerebral blood flow changing mean arterial blood pressure. Another 6 animals were used to assess hypercapnia generated by decreasing ventilatory settings and complementary CO₂ through the ventilator circuit and hypocapnia due to increasing ventilatory settings. Cerebral blood flow was determined by jugular vein blood flow by Doppler and continuously monitored with NIRS. A decrease in PaCO₂ was observed after hyperventilation (47.6±2.4 to 29.0±4.9 mmHg). An increase in PaCO₂ was observed after hypoventilation (48.5±5.5 to 90.4±25.1 mmHg). A decrease in cerebral blood flow after hyperventilation (21.8±10.4 to 15.1±11.0 mL/min) and an increase after hypoventilation (23.4±8.4 to 38.3±10.5 mL/min) were detected by Doppler ultrasound. A significant correlation was found between cerebral oxygenation and Doppler-derived parameters of blood flow and PaCO₂. Although cerebral NIRS monitoring is mainly used to detect changes in regional brain oxygenation, modifications in cerebral blood flow following experimental PaCO₂ changes were detected in newborn piglets when no other important variables were modified.

Analysis of the vomeronasal organ transcriptome reveals variable gene expression depending on age and function in rabbits

The vomeronasal organ (VNO) is a chemosensory organ specialized in pheromone detection that shows a broad morphofunctional and genomic diversity among mammals. However, its expression patterns have only been well-characterized in mice. Here, we provide the first comprehensive RNA sequencing study of the rabbit VNO across gender and sexual maturation stages. We characterized the VNO transcriptome, updating the number and expression of the two main vomeronasal receptor families, including 128 V1Rs and 67 V2Rs. Further, we defined the expression of formyl-peptide receptor and transient receptor potential channel families, both known to have specific roles in the VNO. Several sex hormone-related pathways were consistently enriched in the VNO, highlighting the relevance of this organ in reproduction. Moreover, whereas juvenile and adult VNOs showed significant transcriptome differences, male and female did not. Overall, these results contribute to understand the genomic basis of behavioural responses mediated by the VNO in a non-rodent model.

Low frequency of cytomegalovirus (CMV) disease despite high prevalence of CMV viraemia in patients with advanced HIV infection: a clinical and immunological 48-week follow-up study

OBJECTIVES

The aim of the study was to investigate the dynamics of cytomegalovirus (CMV) replication and CMV-specific immune response recovery after antiretroviral treatment (ART) initiation in patients with advanced HIV infection.

METHODS

A prospective observational study of patients with HIV infection and CD4 counts of < 100 cells/µL was carried out (September 2015 to July 2018). HIV viral load (VL), CD4 count and CMV VL were determined by quantitative polymerase chain reaction (PCR) at baseline and at 4, 12, 24 and 48 weeks, and CMV-specific immune response was determined by QuantiFERON-CMV assay at baseline and 48 weeks. All patients were started on ART but only those with CMV end-organ disease (EOD) received anti-CMV treatment.

RESULTS

Fifty-three patients with a median age of 43.6 [interquartile range (IQR) 36.7-52.4] years were included in the study. At baseline, the median CD4 count was 30 cells/µL (IQR 20-60 cells/µL) and the median HIV VL was 462 000 HIV-1 RNA copies/mL (IQR 186 000-1 300 000 copies/mL). At baseline, 32% patients had detectable CMV viraemia but none had detectable CMV viraemia at 48 weeks. Only one of 53 (1.9%) patients developed EOD during follow-up. Seven (13.2%) patients were lost to follow-up and six (11.3%) died; none of the deaths was related to CMV. Similar percentages of patients had a CMV-specific immune response at baseline (71.7%) and at 48 weeks (70.0%). The magnitude of this response tended to increase over time [median 1.63 (IQR 0.15-5.77) IU/mL at baseline vs. median 2.5 (IQR 0.1-8.325) IU/mL at 48 weeks; P = 0.11]. We did not find any risk factors associated with 48-week mortality.

CONCLUSIONS

Although the prevalence of CMV viraemia in patients with advanced HIV infection remains high, achieving a good immunological recovery through ART is enough to suppress CMV viraemia, without an increased risk of CMV EOD. The prevalence of a CMV-specific immune response was high and endured over time.

Diagnostic accuracy of combining C-Reactive protein and Alvarado Score among 2-to-20-year-old patients with acute appendicitis suspected presenting to Emergency Departments

OBJECTIVE

Main objective was whether the combination of C-Reactive Protein (CRP) and Alvarado Score (AS) increase the diagnosis accuracy of AS among 2-to-20-year-old patients with suspected acute appendicitis presenting to Emergency Departments.

METHODS

This is a secondary analysis of prospective cohort study consecutively including all patients from 2 to 20 years of age attended for suspected acute appendicitis in 4 Spanish Emergency Departments during 6-month period. We collected demographic, clinical, analytic and radiographic, and surgical data. AS categories were retrospectively calculated as low (0-4 points), intermediate (5-6 points) or high (7-10 points). The cut-off levels were >0.5 mg/dl for CRP. The outcome was diagnosis of acute appendicitis within 14 days of the index visit.

RESULTS

A total of 331 patients with suspected of acute appendicitis (mean age 11.8 (SD 3.8) years; 52.9% males) were recruited. According to AS, 108 (32.6%) were at low risk, 76 at (23.0%) intermediate risk and 147 (44.4%) at high risk of acute appendicitis. One hundred and sixteen (35.0%) cases had confirmed histopathological diagnosis of acute appendicitis. The AUCs of ROC were 0.76 (0.70-0.81) for AS and 0.79 (95% CI 0.75-0.84) for CRP-AS being the difference statistically significant (p=0.003). The CRP for diagnosis acute appendicitis in low risk AS group had negative predictive value of 95.8% (95%CI 87.3-98.9) and likelihood ratio negative of 0.4 (95%CI 0.2-1.0)..

CONCLUSIONS

CRP-AS has shown to increase the diagnostic accuracy of AS for acute appendicitis. This approach may be useful to rule out the diagnosis of acute appendicitis in paediatric patients attended for abdominal pain suggestive of acute appendicitis.

Energy, nitrogen partitioning, and methane emissions in dairy goats differ when an isoenergetic and isoproteic diet contained orange leaves and rice straw crop residues

The aim of this study was to evaluate the effects of incorporating rice straw and orange leaves into the diets for goats. Ten Murciano-Granadina goats at mid lactation weighing 45 ± 0.3 kg were used in a crossover design. Two isoproteic and isoenergetic diets (180 g/kg DM and 17 MJ/kg DM, respectively) with alfalfa hay as forage source (33% of DM) were fed. A control diet (CON) incorporated barley as energy source and soy hulls as fiber component. The experimental diet (ORG) replaced barley and soy hulls with orange leaves (19% on DM basis), rice straw (12%, on DM basis) and soya oil (2%). Peas and horsebeans were the protein source in both diets. Each goat received the 2 treatments in 2 periods. Goats were fed the experimental diets and after 14 d on their respective treatments moved to individual metabolism cages for another 7 d. Subsequently, feed intake, total fecal and urine output and milk yield were recorded daily over the first 5 d. During the next 2 d ruminal fluid and blood samples were collected, and then individual gas-exchange measurements were recorded by a mobile open-circuit indirect calorimetry system using a head box. No differences in dry matter intake were detected, and apparent total-tract digestibility was greater in CON than ORG. Efficiency of metabolizable energy intake for milk and maintenance also was lower in response to ORG (0.65 vs. 0.63), with energy balance being negative (-12 kJ/kg of BW^0.75) due to mobilization of fat (-16 g/animal vs. 68 g/animal for ORG and CON, respectively). Although actual milk yield was lower in goats fed ORG (2.32 vs. 2.06 kg/d, respectively), energy-corrected milk did not differ (2.81 kg/d on average). In terms of milk quality, milk fat content, and concentrations of monounsaturated (18.54 vs. 11.55 g/100 g milk fat) and polyunsaturated fatty acids (5.75 vs. 3.99 g/100 g milk fat) were greater in goats fed ORG. Based on various indices, the milk produced by ORG would be less atherogenic and thrombogenic than CON milk. Compared with CON, enteric CH₄ emission was lower due to feeding ORG (reduction of 38 g CH₄/kg milk fat). Data suggest that greater fat mobilization in goats fed ORG might have been due to the apparent lack of synchrony between degradable protein and carbohydrate and the lipogenic nutrients associated with the lower cereal content of the ORG diet. Thus, goats fed ORG seemed to rely more on fat depots to help meet energy requirements and reach optimal performance. As such, the lower content of glucogenic nutrients in ORG did not favor body fat deposition and partitioning of ME into body tissue. Overall, responses in terms of CH₄ emissions and milk quality suggest that inclusion of rice straw and orange leaves in diets for small ruminants could be a valuable alternative to reuse, recycle and revalue agricultural by-products.

Cellular response of human apical papilla cells to calcium hydroxide and tricalcium silicate-based cements

Background

This study aimed to evaluate the biological response of human apical papilla cells to different calcium hydroxide formulations and three tricalcium silicate-based materials.

Methods

Primary cells were obtained from explants of young immature premolars. 20,000 cells adhered for 24 h over discs of Biodentine™, ProRoot®MTA, BioRoot®RCS and calcium hydroxide mixed either with sodium chloride 0.9%w/v or polyethylene glycol and UltraCal® were used to evaluate cell adhesion by scanning electron microscopy and cell viability by MTT assay.

Results

Cells adhered to ProRoot®MTA showed an increase of F-actin like protrusions, suggesting bioactivity. Cells adhered to UltraCal® show protrusion such as filopodia. On the contrary, cells adhered to BioRoot®RCS showed no signs of any cellular protrusion. Regarding viability between the materials, we found a higher percentage of viability in cells cultured over discs of Biodentine™ and ProRoot®MTA.

Conclusion

ProRoot®MTA and Biodentine™ exhibit a better cellular response of human apical papilla cells in vitro conditions compared to BioRoot® and calcium hydroxide diluted in sodium chloride.

Environmental refuges increase performance of juvenile mussels Mytilus chilensis: Implications for mussel seedling and farming strategies

Estuarine ecosystems are characterized by a wide physical-chemical variation that in the context of global change scenarios may be exacerbated in the future. The fitness of resident organisms is expected to be influenced by such variation and, hence, its study is a priority. Some of that variation relates to water vertical stratification, which may create "environmental refuges" or distinct layers of water with conditions favoring the fitness of some individuals and species. This study explored the performance of juvenile mussels (M. chilensis) settled in two distinctive water depths (1 m and 4 m) of the Reloncaví fjord (southern Chile) by conducting a reciprocal transplants experiment. Salinity, saturation state and the contents of CO₃ in seawater were among the factors that best explained the differences between the two layers. In such environmental conditions, the mussel traits that responded to such variation were growth and calcification rates, with significantly higher values at 4 m deep, whereas the opposite, increased metabolic stress, was higher in mussels raised and transplanted to the surface waters (1 m). Such differences support the notion of an environmental refuge, where species like mussels can find better growth conditions and achieve higher performance levels. These results are relevant considering the importance of M. chilensis as a shellfish resource for aquaculture and a habitat forming species. In addition, these results shed light on the variable responses exhibited by estuarine organisms to small-scale changes in the characteristics of the water column, which in turn will help to better understand the responses of the organisms to the projected scenarios of climate global change.

Growth rates in two natural populations of Gasterosteus aculeatus in northwestern Spain: relationships with other life history parameters

We analysed growth rates of two natural populations of the three–spined stickleback fish, Gasterosteus aculeatus, in Galicia (north–west of Spain) where it has a strictly annual life cycle. We used the von Bertalanffy growth model to estimate nonlinear function for length–at–age data sets. These European peripheral populations reach the highest growth rates (k of the von Bertalanffy model > 0.4 month–1) known for this species. Instantaneous mortality rates and fecundity were computed using von Bertalanffy model parameters for each population. Mortality rates found in Galician populations were 2.0–2.3 higher times than those observed in general for Gasterosteidae. Combining both mortality and fertility, different intermediate fitness optima in each population were obtained for mature females. Overall, these differences in life history compared to other studied populations of sticklebacks can be interpreted as local adaptations to a Mediterranean climate type with high degree–days. Consequently, these populations at the edges of the species’ range may have adapted to the unique environmental conditions and may be of interest in ecology and conservation.

Effect assessment of reclaimed water and carbamazepine exposure on the thyroid axis of X. laevis: Apical and histological effects

There is increasing environmental concern about the constant presence of pharmaceuticals and personal care products (PPCPs) in surface water, generally attributed to water discharge from wastewater treatment plants (WWTPs) that are unable to completely remove these compounds. The slight, but continuous, presence of these contaminants in reclaimed water (RW) poses a risk of chronic and sublethal toxicity, and the thyroid axis can likely be a target of many of these PPCPs. In this work, we addressed the effects of RW on the Xenopus laevis thyroid system. The Amphibian Metamorphosis Assay (AMA test) was used with modifications by exposing X. laevis tadpoles to RW samples, and to RW spiked with carbamazepine (CBZ) at 100 and 1000 higher than the average levels environmentally relevant (RW 100× and RW 1000×, respectively). Carbamazepine was selected because it is considered a marker of anthropogenic pollution and could have a potential effect on the thyroid axis. The morphological endpoints and histological alterations to the thyroid gland were evaluated. The results suggested the stimulation of the thyroid gland from exposures to the RW samples, supported by tadpoles' accelerated development and by the histological alterations observed in the thyroid gland. Developmental acceleration was also seen in the tadpoles exposed to the RW-100× and -1000× samples at comparable levels to those seen in exposures to RW samples alone. Hence CBZ did not seem to increase the effects of RW on the thyroid axis. Overall, our results suggested endocrine effects of these RW samples regardless of the CBZ concentration.

Inclusion of lemon leaves and rice straw into compound feed and its effect on nutrient balance, milk yield, and methane emissions in dairy goats

The objective of this experiment was to study the effects of incorporating lemon leaves and rice straw into the compound feed of diets for dairy goats. Ten Murciano-Granadina dairy goats (n = 5 per group) in mid-lactation were used in a crossover design experiment (2 treatments across 2 periods). Goats were fed a mixed ration with barley grain (control, CON) or CON plus lemon leaves [189 g/kg of dry matter (DM)] and rice straw (120 g/kg of DM) in place of barley grain (LRS). Soybean oil (19 g/kg of DM) was added to the LRS diet to make it isoenergetic (17 MJ of gross energy/kg of DM) relative to CON. After 14 d on their respective treatments, goats were allocated to individual metabolism cages for another 7 d. Subsequently, feed intake, total fecal and urine output, and milk yield were recorded daily over the first 5 d. During the last 2 d, ruminal fluid and blood samples were collected, along with individual gas exchange measurements recorded by a mobile open-circuit indirect calorimetry system using a head box. No differences in DM intake were detected, and ME intake in LRS was lower than in CON (1,095 vs. 1,180 kJ/kg of metabolic body weight). No differences were observed in milk production, but milk fat content was greater in LRS (6.4%) than in CON (5.6%). Greater concentrations of monounsaturated (14.94 vs. 11.96 g/100 g of milk fat) and polyunsaturated fatty acids (4.53 vs. 4.03 g/100 g of milk fat) were detected in the milk of goats fed LRS compared with CON. Atherogenicity (2.68 vs.1.91) and thrombogenic (4.58 vs. 2.81) indices were lower with LRS compared with CON. Enteric CH₄ emission was lower in LRS (24.3 g/d) compared with CON (31.1 g/d), probably due to the greater lipid content and unsaturated fatty acid profile of lemon leaves and the soybean oil added in the LRS diet. Overall, data suggest that incorporating lemon leaves and rice straw into lactating goat diets is effective in reducing CH₄ emissions while allowing improvements in milk fat production and milk thrombogenic index without affecting production performance. Thus, their inclusion in compound feeds fed to small ruminants appears warranted and would have multiple positive effects, as on efficiency of nutrient use, human health, and the environment.

Development and evaluation of a mechanistic model of post-absorptive nitrogen partitioning in lactating goats

Context Goats contribute to global warming through emission of nitrous oxide from urine and faeces. To reduce nitrogen (N) excretion, improvements of N efficiency of goats is necessary. Aims The aim of the present study was to develop and evaluate a dynamic mechanistic research-oriented model that explicitly represents N partition into faeces, urine and milk in dairy goats fed total mixed rations. Methods Data from five N-balance dairy-goat experiments were used to develop a mechanistic dynamic model of post-absorptive N partition. Various representations considering either mass action or Michaelis–Menten kinetics of N usage for milk were proposed. Key results The data for faecal and urine N responses were best fit by a straight line; whereas, data for milk N responses were best fit by curvilinear saturating curve. The model with curvilinear saturating curve had more precise parameter estimates, with the predicted N excretion in faeces (15.6 g/day), urine (15.4 g/day) and milk N output (11.7 g/day) being very close to the observed values, namely, 15.31 g N/day in faeces, 18.78 g N/day in urine and 12.24 g N/day in milk. Independent datasets with 12 studies were used to evaluate the model. The model tended to under-predict faecal N outflow at a lower N intake level and urinary N outflow at a higher N intake level, with the lowest mean bias for milk N outflow. Conclusions The final chosen model was adequate to represent faecal, urinary and milk N outflows in dairy goats. Implications The model has provided a mechanistic description of N usage, which is useful to frame and test hypotheses of physiological regulation of N use by goats, and focus on a more efficient transfer of dietary N into milk, reducing the N excretion in faeces and urine.

[Cardiovascular Preparticipation Screening of young population. Position statement of Chilean Scientific Societies]

The Preparticipation Physical Evaluation (PPE), defined as "the health supervision of individuals, prior to the practice of physical activity and/or sports, which seeks to optimize their safe participation in sports and provide an opportunity to identify current and future risks to their health and quality of life", inclu des the Cardiovascular assessment, which aims to screen cardiovascular pathologies with the risk of worsening or sudden death during exercise. Although there is broad international consensus that the use of Pediatric Cardiovascular PPE in young athletes is useful, there is no consensus on whether this should be used in the entire pediatric population or on which is the best strategy to apply. This article presents the position of the scientific societies related to sport, physical activity and child health on the Pediatric Cardiovascular PPE.

Absorption of wireless radiation in the child versus adult brain and eye from cell phone conversation or virtual reality

Children's brains are more susceptible to hazardous exposures, and are thought to absorb higher doses of radiation from cell phones in some regions of the brain. Globally the numbers and applications of wireless devices are increasing rapidly, but since 1997 safety testing has relied on a large, homogenous, adult male head phantom to simulate exposures; the "Standard Anthropomorphic Mannequin" (SAM) is used to estimate only whether tissue temperature will be increased by more than 1 Celsius degree in the periphery. The present work employs anatomically based modeling currently used to set standards for surgical and medical devices, that incorporates heterogeneous characteristics of age and anatomy. Modeling of a cell phone held to the ear, or of virtual reality devices in front of the eyes, reveals that young eyes and brains absorb substantially higher local radiation doses than adults'. Age-specific simulations indicate the need to apply refined methods for regulatory compliance testing; and for public education regarding manufacturers' advice to keep phones off the body, and prudent use to limit exposures, particularly to protect the young.

Classifying different Iberian pig genetic lines by applying chemical-instrumental parameters of dry-cured Iberian shoulders

Iberian pigs are an autochthonous porcine breed mainly bred in southwestern of Iberian Peninsula, this herd traditionally feeds on acorn and pasture, in an extensive production system. In this study, the main objective was for classifying Iberian shoulders from different genetic lines of pigs and their crossed genetic lines. For that, morphology parameters, fatty acid profile and volatile compounds were determined on two batches of dry-cured Iberian shoulders. The samples were acquired from the same place of the dry-cured Iberian shoulders. From these data, two databases were created, for training and validation purpose. Results on this study, firstly demonstrate the capability of data mining techniques in order to classify shoulder as function as Iberian pig genetic lines by using of different quality characteristics. Four classification models were developed and tested in the training database and all models achieved a percentage of correct classification higher than 75%. Then, the same four classification models were performed in the validation database and the model of J48 decision tree and fatty acid profile reached the highest correct classification percentage (91.67%), and from Retinto genetic line (95.65%). From this classification model, a software application was developed in order to determine in a semi-automatic way the genetic line of the dry-cured Iberian shoulder. This application could be used in the meat industries for determining relationships between genetic line and meat quality or performance of noble parts.

Sublethal and chronic effects of reclaimed water on aquatic organisms. Looking for relationships between physico-chemical characterisation and toxic effects

The use of reclaimed water for irrigation and aquaculture purposes is generally considered a reliable alternative for sustainable water management in regions with water scarcity. Many organic compounds, generally called compounds of emerging concern (CECs), have been detected in reclaimed water, which implies continuous exposure for aquatic organisms. To date no quality criteria have been proposed for this group of compounds. This work aims to assess the acute, sublethal and chronic effects of reclaimed water using two representative organisms of the aquatic compartment; the green alga Chlorella vulgaris and the microcrustacean Daphnia magna. The study comprises the 72 h-algal growth inhibition test, the D. magna feeding bioassay and the D. magna reproduction test. The results highlighted, for the selected characterised compounds, no differences in the concentrations between the different tertiary WWTP treatments, except for the particular case of carbamazepine. Considering seasonality, no differences were observed between the two different sample collection campaigns. The sublethal and chronic effects observed for these samples could not be explained by the lower concentrations found in the chemical characterisation. However, in the majority of cases, dilution of raw reclaimed water reduced the toxic effects of these samples. Several interactions among compounds can affect the mixture's toxicity. Canonical correlation analyses (CCA) were included to explore the potential relationships between the physico-chemical characterisation of reclaimed water and effects on aquatic organisms. The results corroborated the toxic effect of some pharmaceuticals, in particular beta-blockers and antibiotics, on the growth and yield of green algae, as well as inhibition of daphnia reproduction. Thus the CCA methods could help to elucidate the potential relationships between the physico-chemical characterisation and toxic effects by considering all the potential interactions.

Intrathecal administration of autologous bone marrow stromal cells improves neuropathic pain in patients with spinal cord injury

Neuropathic pain (NP) is highly disabling, responds poorly to pharmacological treatment, and represents a significant cause of decreased quality of life in patients suffering from spinal cord injury (SCI). In recent years, cell therapy with autologous mesenchymal stromal cells (MSCs) has been considered as a potential therapeutic weapon in this entity. Ten patients suffering chronic SCI received 100 million MSCs into subarachnoid space by lumbar puncture (month 1 of the study) and this procedure was repeated at months 4 and 7 until reaching a total doses of 300 million MSCs. Intensity of NP was measured by standard numerical rating scale (VAS) from 0 to 10, recording scores previous to the first MSCs administration and monthly, until month 10 of follow-up. Months 1, 4, 7 and 10 of the study were selected as time points in order to a statistical analysis by the nonparametric Wilcoxon rank test. Our results showed significant and progressive improvement in NP intensity after the first administration of MSCs (p: 0.003). This study supports the benefit of intrathecal administration of autologous MSCs for the treatment of NP in patients with SCI.

Phase II randomized study of PM01183 versus topotecan in patients with platinum-resistant/refractory advanced ovarian cancer

Background

PM01183 is a new compound that blocks active transcription, produces DNA breaks and apoptosis, and affects the inflammatory microenvironment. PM01183 showed strong antitumor activity in preclinical models of cisplatin-resistant epithelial ovarian cancer.

Patients and methods

Patients with platinum-resistant/refractory ovarian cancer were included in a two-stage, controlled, randomized (in a second stage), multicenter, phase II study. Primary endpoint was overall response rate (ORR) by RECIST and/or GCIG criteria. The exploratory first stage (n = 22) confirmed the activity of PM01183 as a single agent at 7.0 mg flat dose every 3 weeks (q3wk). The second stage (n = 59) was randomized and controlled with topotecan on days 1-5 q3wk or weekly (every 4 weeks, q4wk).

Results

ORR was 23% (95% CI, 13%-37%) for 52 PM01183-treated patients. Median duration of response was 4.6 months (95% CI, 2.5-6.9 months), and 23% (95% CI, 0%-51%) of responses lasted 6 months or more. Ten of the 12 confirmed responses were reported for 33 patients with platinum-resistant disease [ORR = 30% (95% CI, 16%-49%)]; for the 29 patients treated with topotecan in the second stage, no responses were found. Median PFS for all PM01183-treated patients was 4.0 months (95% CI, 2.7-5.6 months), and 5.0 months (95% CI, 2.7-6.9 months) for patients with platinum-resistant disease. Grade 3/4 neutropenia in 85% of patients; febrile neutropenia in 21% and fatigue (grade 3 in 35%) were the principal safety findings for PM01183.

Conclusion

PM01183 is an active drug in platinum-resistant/refractory ovarian cancer and warrants further development. The highest activity was observed in platinum-resistant disease. Its safety profile indicates the dose should be adjusted to body surface area (mg/m2).

Trial code

EudraCT 2011-002172-16.

Aged blood factors decrease cellular responses associated with delayed gingival wound repair

Aging is a gradual biological process characterized by a decrease in cell and organism functions. Gingival wound healing is one of the impaired processes found in old rats. Here, we studied the in vivo wound healing process using a gingival repair rat model and an in vitro model using human gingival fibroblast for cellular responses associated to wound healing. To do that, we evaluated cell proliferation of both epithelial and connective tissue cells in gingival wounds and found decreased of Ki67 nuclear staining in old rats when compared to their young counterparts. We next evaluated cellular responses of primary gingival fibroblast obtained from young subjects in the presence human blood serum of individuals of different ages. Eighteen to sixty five years old masculine donors were classified into 3 groups: “young” from 18 to 22 years old, “middle-aged” from 30 to 48 years old and “aged” over 50 years old. Cell proliferation, measured through immunofluorescence for Ki67 and flow cytometry for DNA content, was decreased when middle-aged and aged serum was added to gingival fibroblast compared to young serum. Myofibroblastic differentiation, measured through alpha-smooth muscle actin (α-SMA), was stimulated with young but not middle-aged or aged serum both the protein levels and incorporation of α-SMA into actin stress fibers. High levels of PDGF, VEGF, IL-6R were detected in blood serum from young subjects when compared to middle-aged and aged donors. In addition, the pro-inflammatory cytokines MCP-1 and TNF were increased in the serum of aged donors. In old rat wound there is an increased of staining for TNF compared to young wound. Moreover, healthy gingiva (non injury) shows less staining compared to a wound site, suggesting a role in wound healing. Moreover, serum from middle-aged and aged donors was able to stimulate cellular senescence in young cells as determined by the expression of senescence associated beta-galactosidase and histone H2A.X phosphorylated at Ser139. Moreover, we detected an increased frequency of γ-H2A.X-positive cells in aged rat gingival tissues. The present study suggests that serum factors present in middle-aged and aged individuals may be responsible, at least in part, for the altered responses observed during wound healing in aging.

Evaluation of Hematobin as a Vaccine Candidate to Control Haematobia irritans (Diptera: Muscidae) Loads in Cattle

The horn fly, Haematobia irritans (L.), is a blood-sucking livestock ectoparasite responsible for substantial livestock losses. In the present work, the potential use of recombinant hematobin (HTB), a horn fly salivary protein, as an antigen for cattle vaccination was investigated. In this trial, horn fly loads and H. irritans's blood intake were assessed in vaccinated (n = 4) and control (n = 4) crossbred dark-coated steers, which were naturally infected. The vaccinated group received a 1 ml subcutaneous injection of 100 µg of HTB protein emulsified in 500 µl of Incomplete Freund Adjuvant (AIF) on days 0 and 30. The control group received on the same days 1 ml of distilled water emulsified in 500 µl of AIF. The vaccinated group had significantly more HTB-specific IgG antibodies after the HTB booster and had a lower fly load than the control group (206 ± 23 vs. 285 ± 23 flies per animal, respectively). Blood intake by H. irritans did not differ between groups. In summary, these results suggest that vaccinating cattle with HTB could reduce cattle H. irritans load.

The civic integrationist turn in Danish and Swedish school politics

The civic integrationist turn usually refers to the stricter requirements for residence and citizenship that many states have implemented since the late 1990's. But what of other policy spheres that are essential for the formation of citizens? Is there a civic turn in school policy? And does it follow the pattern of residence and citizenship? This article addresses these questions through a comparative study of the EU's allegedly strictest and most liberal immigration regimes, Denmark and Sweden, respectively. The analysis shows a growing concern with citizenship education in both countries, yet with different styles and content. Citizenship education in Denmark concentrates on reproducing a historically derived core of cultural values and knowledge to which minorities are expected to assimilate, while the Swedish model subscribes to a pluralist view that stresses mutual adaptation and intercultural tolerance. Despite claims to the contrary, the analysis shows that Sweden too has experienced a civic turn.

A Natural Cattle Immune Response Against Horn Fly (Diptera: Muscidae) Salivary Antigens May Regulate Parasite Blood Intake

The horn fly, Haematobia irritans (L.), is a blood-sucking ectoparasite that is responsible for sizeable economic losses in livestock. The salivary gland products facilitate blood intake. Taking advantage of the identification of novel H. irritans salivary antigens (Hematobin, HTB and Irritans 5, IT5), we investigated the parasite loads, H. irritans blood intake, and antibody response of naturally infected bovines during the fly season. Fly loads and fly hemoglobin content fluctuated during the trial. Each time horn fly loads exceeded 200 flies per cattle, a reduction in horn fly blood intake was observed three weeks later. All of the cattle elicited an antibody response against HTB and IT5 that declined once the fly season was over. Cattle anti-IT5 titers were positively correlated with parasite loads and negatively correlated with fly blood intake. These results suggest that the natural changes in the H. irritans blood intake observed in this study were associated with a natural host response against horn fly salivary antigens.

Effect of rice bran as a replacement for oat grain in energy and nitrogen balance, methane emissions, and milk performance of Murciano-Granadina goats

The objective of this experiment was to study the effects of substituting oat grain with rice bran on energy, nitrogen and carbon balance, methane emissions, and milk performance in dairy goats. Ten Murciano-Granadina dairy goats in late lactation (46.1 ± 3.07 kg) were assigned to 2 treatments in a crossover design, where each goat received both treatments in 2 periods. One group of 5 goats was fed a mixed ration with 379 g of oat grain/kg of dry matter (O diet) and the other group of 5 goats was fed a diet that replaced oat grain with 379 g/kg dry matter of rice bran (RB diet). Diets were formulated to be isoenergetic and isoproteic, so bypass fat was added to reach the same amount of energy in both diets. The goats were allocated to individual metabolism cages. After 14 d of adaptation, feed intake, total fecal and urine outputs, and milk yield were recorded daily over a 5-d period. Then, gas exchange measurements were recorded individually by a mobile open-circuit indirect calorimetry system using a head box. Dry matter intake was different for both diets [1.83 ± 0.11 vs. 1.61 ± 0.08 (means ± SD), for O and RB, respectively]. Metabolizable energy intake and heat production were not significantly different between diets, with average values of 1,254 [standard error of the mean (SEM) = 110.0] and 640 (SEM = 21.0) kJ/kg of BW(0.75), respectively. Significant differences were found in milk fat content (5.3 and 6.9%, SEM = 0.36; for O and RB, respectively) and milk fatty acids: medium-chain fatty acids (17.17 vs. 12.90 g/100g, SEM = 0.969; for O and RB, respectively) and monounsaturated fatty acids (20.63 vs. 28.29 g/100g, SEM = 1.973; for O and RB, respectively). Enteric CH4 emission was lower for the RB diet (23.2 vs. 30.1g/d, SEM = 2.14; for O and RB, respectively), probably because of the higher lipid content in RB diets than O diets (11.7 vs. 4.1%, respectively). Lactating goats utilized RB without detrimental effects on energy metabolism. Higher milk fat and lower CH4 emissions were observed with the RB diet compared with the O diet.

Modelling and kinetics studies of a corn-rape blend combustion in an oxy-fuel atmosphere

A kinetic oxy-combustion study of a previously optimized lignocellulose blend is proposed. Kinetic and diffusion control mechanism are considered. The proposed correlations fit properly with the experimental results and diffusion effects are identified as be important enough to be taken into account. Afterwards, with the results obtained in the kinetic study, a detailed consecutive and parallel kinetic scheme is proposed for modelling the oxy-combustion of the blend. A discussion of the temperature and concentration profiles are included. Variation of products final distribution is considered. Smaller particles than 0.001 m are proposed for reducing temperature and concentration profiles and obtaining a good final product distribution. CO2-char reaction is identified as one of the most important step to be optimized for obtaining the lowest final residue. In this study, char is mainly oxidised at 950 K and this situation is attributed to an optimized blending of the bioresidues.

Biohydrogen production from lactose: influence of substrate and nitrogen concentration

Hydrogen produced from renewable sources may be considered the energy vector of the future. However, reducing process costs is imperative in order to achieve this goal. In the present research, the effect of nitrogen (N), initial pH and substrate content for starting up the dark fermentative process was studied using the response surface methodology. Anaerobic digested dried sludge (biosolid pellets) was used as the inoculum. Synthetic wastewater was used as the substrate in batch reactors. A decrease in H2 production was observed with the increase in N and lactose concentrations. This drop was considerably greater when the concentration of lactose was at its lower level. Although the increase in lactose concentration results in a lower H2 production, the effect of N on the response is attenuated at higher levels of lactose. On the other hand, the effect of initial pH on the fermentation system was not significant. The evaluation on the process under semi-continuous conditions was performed using anaerobic sequencing batch reactors (ASBRs). The process was evaluated at different C/N ratios using synthetic wastewater. Results showed higher hydrogen yields with the gradual decrease in nitrogen content. The addition of cheese whey to the ASBR resulted in a H2 production rate of 0.18 L H2 L(-1) d(-1).

Environmental and health benefits from designating the Marmara Sea and the Turkish Straits as an emission control area (ECA)

Ship emissions degrade air quality and affect human health, and are increasingly becoming a matter of concern. Sulfur emission control areas (ECA), specific coastal regions where only low-sulfur fuels may be consumed by ocean-going ships, have proven to be useful tools to reduce ship-sourced air pollution along the North American, Canadian, and European North and Baltic Sea coastlines. The present work assesses the environmental and health benefits which would derive from designating an ECA in the Marmara Sea and the Turkish Straits (50 000 ships/year; 23 million inhabitants). Results show evidence that implementing an ECA would be technically viable and that it would reduce ship-sourced PM10 and PM2.5 ambient concentrations in Istanbul by 67%, and SO2 by 90%. The reduction of the air pollution burden on health was quantified as 210 hospital admissions from exposure to PM10, 290 hospital admissions from exposure to SO2, and up to 30 premature deaths annually due to ECA emission controls. Consequently, the designation of an ECA in the Marmara Sea and the Turkish Straits is evaluated as a positive, technically viable and real-world measure to reduce air pollution from ships in Turkey.

Effect of replacing dietary corn with beet pulp on energy partitioning, substrate oxidation and methane production in lactating dairy goats

The objective of this experiment was to study the effect of substitution of corn by beet pulp on energy partitioning, substrate oxidation, nitrogen and carbon balance and milk performance in dairy goats during late lactation. Twelve multiparous lactating Murciano-Granadina goats were fed two diets. Six goats were fed a mixed ration with 310 g/kg DM of ground corn (diet CORN) and in the other diet the corn was substituted with 302 g/kg DM of beet pulp (diet BP) in a cross-over design. No significant differences between diets were observed for milk production (1.36 kg/day, on average) and differences were found for milk fat (5.39 and 4.21% for BP and CORN, respectively). The metabolisable energy intake was higher (P < 0.05) in the CORN diet than BP (1320 vs 1044 kJ/kg0.75 BW, respectively). The difference in methane emissions between treatments was significant (P < 0.05) with values of 92 vs 61 kJ/kg0.75 BW for BP and CORN, respectively, indicating that greater levels of starch in diet reduce methane production. Replacing corn with BP reduced significantly the energy body fat deposition (300 vs 44 kJ/kg0.75 BW for CORN and BP diets, respectively). This reduction in energy retention for the BP diet did not compromise milk yield and milk energy output.