Selective recovery of boron, cobalt, gallium and germanium from seawater solar saltworks brines using N-methylglucamine sorbents: Column operation performance

The European Union (EU) identified a list of Critical Raw Materials (CRMs) crucial for its economy, aiming to find alternative sources. Seawater is a promising option as it contains almost all elements, although most at low concentrations. However, to the present, the CRMs' recovery from seawater is technically and economically unfeasible. Other alternatives to implement sea mining might be preferred, such as reverse osmosis brines or saltworks bitterns (after sodium chloride crystallisation). The CRMs' extraction in a selective way can be achieved using highly selective recovery processes, such as chelating sorbents. This study focuses on extracting Trace Elements (TEs) from solar saltworks brines, including boron, cobalt, gallium and germanium, using commercial N-methylglucamine sorbents (S108, CRB03, CRB05). The application of these sorbents has shown potential for boron recovery, but their selectivity for cobalt, gallium, and germanium requires further investigation. This research aims to assess these sorbents' kinetics and column mode performance for TEs recovery from synthetic bitterns. Boron and germanium were rapidly sorbed, reaching equilibrium (>90 %) within 1 h, except for S108, which took 2 h. In column mode, 20-25 pore volumes of bittern were treated to remove boron and germanium, but competition from other elements reduced treatment capacity. An acidic elution (1 M hydrochloric acid) allowed to elute them (>90 %), reaching concentration factors for germanium and boron of 35 and 11, respectively, while cobalt and gallium had less affinity for the sorbents. In addition, the experiments performed were fitted by a mass transfer model to determine the equilibrium constants and selectivities. Therefore, bittern mining has been proven as a secondary/alternative source to obtain CRMs, which can lead the EU to a position in which its dependence on other countries to obtain these raw materials would be decreased.

Proteasome-dependent degradation of histone H1 subtypes is mediated by its C-terminal domain

Histone H1 is involved in chromatin compaction and dynamics. In human cells, the H1 complement is formed by different amounts of somatic H1 subtypes, H1.0-H1.5 and H1X. The amount of each variant depends on the cell type, the cell cycle phase, and the time of development and can be altered in disease. However, the mechanisms regulating H1 protein levels have not been described. We have analyzed the contribution of the proteasome to the degradation of H1 subtypes in human cells using two different inhibitors: MG132 and bortezomib. H1 subtypes accumulate upon treatment with both drugs, indicating that the proteasome is involved in the regulation of H1 protein levels. Proteasome inhibition caused a global increase in cytoplasmatic H1, with slight changes in the composition of H1 bound to chromatin and chromatin accessibility and no alterations in the nucleosome repeat length. The analysis of the proteasome degradation pathway showed that H1 degradation is ubiquitin-independent. The whole protein and its C-terminal domain can be degraded directly by the 20S proteasome in vitro. Partial depletion of PA28γ revealed that this regulatory subunit contributes to H1 degradation within the cell. Our study shows that histone H1 protein levels are under tight regulation to prevent its accumulation in the nucleus. We revealed a new regulatory mechanism for histone H1 degradation, where the C-terminal disordered domain is responsible for its targeting and degradation by the 20S proteasome, a process enhanced by the regulatory subunit PA28γ.

Penetrance of Dilated Cardiomyopathy in Genotype-Positive Relatives

BACKGROUND

Disease penetrance in genotype-positive (G+) relatives of families with dilated cardiomyopathy (DCM) and the characteristics associated with DCM onset in these individuals are unknown.

OBJECTIVES

This study sought to determine the penetrance of new DCM diagnosis in G+ relatives and to identify factors associated with DCM development.

METHODS

The authors evaluated 779 G+ patients (age 35.8 ± 17.3 years; 459 [59%] females; 367 [47%] with variants in TTN) without DCM followed at 25 Spanish centers.

RESULTS

After a median follow-up of 37.1 months (Q1-Q3: 16.3-63.8 months), 85 individuals (10.9%) developed DCM (incidence rate of 2.9 per 100 person-years; 95% CI: 2.3-3.5 per 100 person-years). DCM penetrance and age at DCM onset was different according to underlying gene group (log-rank P = 0.015 and P <0.01, respectively). In a multivariable model excluding CMR parameters, independent predictors of DCM development were: older age (HR per 1-year increase: 1.02; 95% CI: 1.0-1.04), an abnormal electrocardiogram (HR: 2.13; 95% CI: 1.38-3.29); presence of variants in motor sarcomeric genes (HR: 1.92; 95% CI: 1.05-3.50); lower left ventricular ejection fraction (HR per 1% increase: 0.86; 95% CI: 0.82-0.90) and larger left ventricular end-diastolic diameter (HR per 1-mm increase: 1.10; 95% CI: 1.06-1.13). Multivariable analysis in individuals with cardiac magnetic resonance and late gadolinium enhancement assessment (n = 360, 45%) identified late gadolinium enhancement as an additional independent predictor of DCM development (HR: 2.52; 95% CI: 1.43-4.45).

CONCLUSIONS

Following a first negative screening, approximately 11% of G+ relatives developed DCM during a median follow-up of 3 years. Older age, an abnormal electrocardiogram, lower left ventricular ejection fraction, increased left ventricular end-diastolic diameter, motor sarcomeric genetic variants, and late gadolinium enhancement are associated with a higher risk of developing DCM.

Imaging leachate runoff from a landfill using magnetotellurics: The Garraf karst case

Electrical and active source electromagnetic geophysical methods have been traditionally employed to approach and tackle environmental problems, such as those caused by landfills. However, since these problems are more consequential and cover broader areas, it is necessary to use deeper penetration methods, such as magnetotellurics. In the Garraf Massif (Catalan Coastal Ranges, NE Spain), an urban waste disposal landfill had been in operation from 1974 to 2006, during which >26 million metric tons of garbage had been deposited. This landfill overlies karstic terrain, thus principally impacting groundwater circulation. Previous electrical resistivity tomography profiles had partially imaged the infill but were not able to penetrate below the base of the original landfill. During 2019 and 2020 we performed a magnetotelluric study over the landfill and its surrounding with the goals of characterizing the electrical resistivity of the infill and below it. The 2D and 3D resistivity models confirmed the highly conductive nature of the leachate and allowed us to identify its presence below the landfill base, which we quantified with maximum thicknesses of 90 m. This proved that landfill leachate had filtered through the original impermeable layer, enhanced by the karstic drainage structure.

Comparing R-Bendamustine vs. R-CHOP Plus Maintenance Therapy as First-Line Systemic Treatment in Follicular Lymphoma: A Multicenter Retrospective GELTAMO Study

Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and R-bendamustine (R-B) are the most common frontline treatment strategies for advanced-stage follicular lymphoma (FL). After R-CHOP induction therapy, using rituximab for maintenance therapy notably improves outcomes; however, whether this can be achieved by using the same approach after R-B therapy is still being determined. This retrospective analysis compared 476 FL patients from 17 GELTAMO centers who received R-based regimens followed by rituximab maintenance therapy for untreated advanced-stage FL. The complete response rate at the end of induction was higher with R-B and relapses were more frequent with R-CHOP. During induction, cytopenias were significantly more frequent with R-CHOP and so was the use of colony-stimulating factors. During maintenance therapy, R-B showed more neutropenia and infectious toxicity. After a median follow-up of 81 months (95% CI: 77-86), the 6-year rates of progression-free survival (PFS) were 79% (95% CI: 72-86) for R-bendamustine vs. 67% (95% CI: 61-73) for R-CHOP (p = 0.046), and 6-year overall survival (OS) values were 91% (95% CI: 86-96) for R-B vs. 91% (95% CI: 87-94) for R-CHOP (p = 0.49). In conclusion, R-B followed by rituximab maintenance therapy in patients with previously untreated FL resulted in significantly longer PFS than R-CHOP, with older patients also benefiting from this treatment without further toxicity. Adverse events during maintenance were more frequent with R-B without impacting mortality.

Factors associated with satisfaction and depressed mood among nursing home workers during the covid-19 pandemic

AIMS AND OBJECTIVES

This paper aims to examine the satisfaction and depressed mood experienced by nursing home workers during the COVID-19 pandemic and associated variables. Specifically, to analyse the factors that may contribute to nursing home workers developing adaptive behaviours that promote satisfaction or, on the contrary, show characteristics associated with a negative mood.

BACKGROUND

Nursing homes have faced unprecedented pressures to provide appropriately skills to meet the demands of the coronavirus outbreak.

DESIGN

A cross-sectional survey design using the STROBE checklist.

METHODS

Professionals working in nursing homes (n = 165) completed an online survey measuring sociodemographic and professional characteristics, burnout, resilience, experiential avoidance, satisfaction with life and depression. Data were collected online from April to July 2021, the time in which Spain was experiencing its fifth wave of COVID-19. Two multiple linear regression models were performed to identify salient variables associated with depressive mood and satisfaction.

RESULTS

Resilience, personal accomplishment and satisfaction had a significant and negative relationship with depression and emotional exhaustion, depersonalisation and experiential avoidance had a positive relationship with depression. However, emotional exhaustion, depersonalisation and experiential avoidance had a negative and significant relationship with satisfaction and personal accomplishment, and resilience had a positive and significant relationship with satisfaction. In addition, it was found that accepting thoughts and emotions when they occur is beneficial for developing positive outcomes such as satisfaction.

CONCLUSIONS

Experiential avoidance was an important predictor of the effects that the COVID-19 pandemic can have on nursing home workers.

RELEVANCE TO CLINICAL PRACTICE

Interventions focusing on resources that represent personal strengths, such as acceptance, resilience and personal accomplishment, should be developed.

NO PATIENT OR PUBLIC CONTRIBUTION

The complex and unpredictable circumstances of COVID's strict confinement in the nursing home prohibited access to the centres for external personnel and family members. Contact with the professionals involved could not be made in person but exclusively through online systems. However, professionals related to the work environment have subsequently valued this research positively as it analyses 'How they felt during this complicated process'.

Development and validation of a clinical score for early diagnosis of constipation in critically ill children

Constipation affects almost 50% of critically ill pediatric patients and is related to their morbidity and mortality. However, little attention is paid to it and it is diagnosed late and when there are already complications. The objective of this study is to develop and validate a score to identify critically ill children with high risk of constipation 48 h after admission. A single center two phase-study was carried out; the first one (retrospective observational study) to develop the score and the second one to validate it in another prospective observational study. Children between 15 days of life and 18 years old admitted to the PICU for more than 3 days were included. Demographic and clinical data during the first 48 h after PICU admission were collected. Univariate and multivariate analysis and ROC curves were used to develop and validate the score. Data from 145 patients (62.8% boys) with a mean age of 34.9 ± 7.3 months were used to develop the score. Independent factors identified to develop the score were: weight > 7 kg, admission to PICU after surgery, need of vasoconstrictors, doses of fentanyl ≥ 2 mcg/kg/h, and initiation of enteral nutrition later than 48 h after admission. Two cut-off values were identified to set low constipation risk (< 5.7 points) and high constipation risk (> 6.2 points). This score was validated in 124 patients showing a sensibility of 63.2%, specificity of 95.5% and a positive/negative predictive values (P/NPV) of 100% and 82.1% respectively to identify constipated patients. This is the first score to identify high constipation risk in critically ill children. This score is easy to apply, and internal validation has shown a PPV of 100%.

Impact of transfer to reference centres and surgical timing on the prognosis of surgically treated patients with infective endocarditis: a prospective multi-centre cohort study

OBJECTIVES

To compare outcomes in patients with infective endocarditis (IE) first treated in secondary hospitals and then transferred to reference centres for surgery with those in patients diagnosed in reference centres, and to evaluate the impact of surgery timing on prognosis.

METHODS

Analysis of a prospective cohort of patients with active IE admitted to three reference centres between 1996 and 2022 who underwent cardiac surgery in the first month after diagnosis. Multi-variable analysis was performed to evaluate the impact of transfer to reference centres and time to surgery on 30-day mortality. Adjusted ORs with 95% CIs were calculated.

RESULTS

Amongst 703 patients operated on for IE, 385 (54.8%) were referred cases. All-cause 30-day mortality did not differ significantly between referred patients and those diagnosed at reference centres (102/385 [26.5%] vs. 78/385 [24.5%], respectively; p 0.552). Variables independently associated with 30-day mortality in the whole cohort were diabetes (OR, 1.76 [95% CI, 1.15-2.69]), chronic kidney disease (OR, 1.83 [95% CI, 1.08-3.10]), Staphylococcus aureus (OR, 1.88 [95% CI, 1.18-2.98]), septic shock (OR, 2.76 [95% CI, 1.67-4.57]), heart failure (OR, 1.41 [95% CI, 0.85-2.11]), acute renal failure before surgery (OR, 1.76 [95% CI, 1.15-2.69]), and the interaction between transfer to reference centres and surgery timing (OR, 1.18 [95% CI, 1.03-1.35]). Amidst referred patients, time from diagnosis to surgery longer than a week was independently associated with 30-day mortality (OR, 2.19 [95% CI, 1.30-3.69]; p 0.003).

CONCLUSION

Among referred patients, surgery performed >7 days after diagnosis was associated with two-fold higher 30-day mortality.

O3-Annealing Effect on the Etching Resilience of a TiO2/Al2O3 filter Prepared by Atomic Layer Deposition

This research investigates the improvements of ozone (O3) annealing on the optical and etching characteristics of TiO2/Al2O3 multilayer band-pass filters designed for potential optoelectronic applications. The band-pass filters were fabricated using atomic layer deposition (ALD), and their performance was systematically analyzed after the addition of O3 annealing at moderate temperatures (up to 300 °C). Results reveal that O3 annealing improves the optical transmittance of the multilayers by approximately 40% without significant spectral changes (∼6 nm). The observed enhancement in the transmittance is attributed to the improved stoichiometry of TiO2. By filling in the oxygen vacancies created during the fabrication process, it reduces its extinction coefficient. Furthermore, the O3 annealing enhances the stability of TiO2 against wet etching, improving the uniformity of etched surfaces. Etching on the ozone-annealed multilayer was up to 8 times more homogeneous, as observed in the roughness. The relatively short duration of the O3 annealing process, approximately 1.6 h, makes it a cost-effective alternative compared to using ozone in the ALD process, which can last several hours for thick optical coatings.

Contemporary Clinical Profile of Left-Sided Native Valve Infective Endocarditis: Influence of the Causative Microorganism

Studies focused on the clinical profile of native valve endocarditis are scarce and outdated. In addition, none of them analyzed differences depending on the causative microorganism. Our objectives are to describe the clinical profile at admission of patients with left-sided native valve infective endocarditis in a contemporary wide series of patients and to compare them among the most frequent etiologies. To do so, we conducted a prospective, observational cohort study including 569 patients with native left-sided endocarditis enrolled from 2006 to 2019. We describe the modes of presentation and the symptoms and signs at admission of these patients and compare them among the five more frequent microbiological etiologies. Coagulase-negative Staphylococci and Enterococci endocarditis patients were the oldest (71 ± 11 years), and episodes caused by Streptococci viridans were less frequently nosocomial (4%). The neurologic, cutaneous or renal modes of presentation were more typical in Staphylococcus aureus endocarditis (28%, p = 0.002), the wasting syndrome of Streptococcus viridans (49%, p < 0.001), and the cardiac in Coagulase-negative Staphylococci, Enterococci and unidentified microorganism endocarditis (45%, 49% and 56%, p < 0.001). The clinical signs agreed with the mode of presentation. In conclusion, the modes of presentation and the clinical picture at admission were tightly associated with the causative microorganism in patients with left-sided native valve endocarditis.

The three-noes right-sided infective endocarditis: An unrecognized type of right-sided endocarditis

The "3 noes right-sided infective endocarditis" (3no-RSIE: no left-sided, no drug users, no cardiac devices) was first described more than a decade ago. We describe the largest series to date to characterize its clinical, microbiological, echocardiographic and prognostic profile. Eight tertiary centers with surgical facilities participated in the study. Patients with right-sided endocarditis without left sided involvement, absence of drug use history and no intracardiac electronic devices were retrospectively included in a multipurpose database. A total of 53 variables were analyzed in every patient. We performed a univariate analysis of in-hospital mortality to determine variables associated with worse prognosis. the study was comprised of 100 patients (mean age 54.1 ± 20 years, 65% male) with definite 3no-RSIE were included (selected from a total of 598 patients with RSIE of all the series, which entails a 16.7% of 3no-RSIE). Most of the episodes were community-acquired (72%), congenital cardiopathies were frequent (32% of the group of patients with previous known predisposing heart disease) and fever was the main manifestation at admission (85%). The microbiological profile was led by Staphylococci spp (52%). Vegetations were detected in 94% of the patients. Global in-hospital mortality was 19% (5.7% in patients operated and 26% in patients who received only medical treatment, P < .001). Non-community acquired infection, diabetes mellitus, right heart failure, septic shock and acute renal failure were more common in patients who died. the clinical profile of 3no-RSIE is closer to other types of RSIE than to LSIE, but mortality is higher than that reported on for other types of RSIE. Surgery may play an important role in improving outcome.

Assessment of the potential value of plasma Torque Teno virus DNA load monitoring to predict cytomegalovirus DNAemia in patients with hematological malignancies treated with small molecule inhibitors: A proof-of-concept study

It is unknown whether Torque Teno virus (TTV) DNA load monitoring could anticipate the development of infectious events in hematological patients undergoing treatment with small molecular targeting agents. We characterized the kinetics of plasma TTV DNA in patients treated with ibrutinib or ruxolitinib and assessed whether TTV DNA load monitoring could predict the occurrence of Cytomegalovirus (CMV) DNAemia or the magnitude of CMV-specific T-cell responses. Multicenter, retrospective, observational study, recruiting 20 patients treated with ibrutinib and 21 with ruxolitinib. Plasma TTV and CMV DNA loads were quantified by real-time PCR at baseline and days +15, +30, +45, +60, +75, +90, +120, +150, and +180 after treatment inception. Enumeration of CMV-specific interferon-γ (IFN-γ)-producing CD8⁺ and CD4⁺ T-cells in whole blood was performed by flow cytometry. Median TTV DNA load in ibrutinib-treated patients increased significantly (p = 0.025) from baseline (median: 5.76 log₁₀ copies/mL) to day +120 (median: 7.83 log₁₀ copies/mL). A moderate inverse correlation (Rho = -0.46; p < 0.001) was found between TTV DNA load and absolute lymphocyte count. In ruxolitinib-treated patients, TTV DNA load quantified at baseline was not significantly different from that measured after treatment inception (p ≥ 0.12). TTV DNA load was not predictive of the subsequent occurrence of CMV DNAemia in either patient group. No correlation was observed between TTV DNA loads and CMV-specific IFN-γ-producing CD8⁺ and CD4⁺ T-cell counts in either patient group. The data did not support the hypothesis that TTV DNA load monitoring in hematological patients treated with ibrutinib or ruxolitinib could be useful to predict either the occurrence of CMV DNAemia or the level of CMV-specific T-cell reconstitution; nevertheless, due to the small sample size, further studies involving larger cohorts are warranted to elucidate this issue.

Prevention of Older Adult Infantilization by Nursing Home Professionals: An Intervention Program

This study analyzes the efficacy of a brief psychoeducational program aimed at preventing older adult infantilization by nursing home professionals. We examined whether an experimental group of professionals reported less infantilization than those of a control group. Changes in stereotypes and humanization were regarded as sub-targets. The sample comprised 154 staff members. Infantilization, humanization, and negative stereotypes toward older adults were assessed before and after the intervention, and repeated measures of ANOVA and one-way ANCOVAs were conducted. Infantilization and negative stereotypes decreased in the experimental group. Significant post-intervention differences were found between the experimental and control groups both in infantilization and negative stereotypes but not in humanization. Results reflect the relevance of developing specific interventions focused on preventing infantilization as well as the need for professionals' training and education to generate a culture of change.

Multi-Step Extracellular Matrix Remodelling and Stiffening in the Development of Idiopathic Pulmonary Fibrosis

The extracellular matrix (ECM) of the lung is a filamentous network composed mainly of collagens, elastin, and proteoglycans that provides structural and physical support to its populating cells. Proliferation, migration and overall behaviour of those cells is greatly determined by micromechanical queues provided by the ECM. Lung fibrosis displays an aberrant increased deposition of ECM which likely changes filament organization and stiffens the ECM, thus upregulating the profibrotic profile of pulmonary cells. We have previously used AFM to assess changes in the Young's Modulus (E) of the ECM in the lung. Here, we perform further ECM topographical, mechanical and viscoelastic analysis at the micro- and nano-scale throughout fibrosis development. Furthermore, we provide nanoscale correlations between topographical and elastic properties of the ECM fibres. Firstly, we identify a softening of the ECM after rats are instilled with media associated with recovery of mechanical homeostasis, which is hindered in bleomycin-instilled lungs. Moreover, we find opposite correlations between fibre stiffness and roughness in PBS- vs bleomycin-treated lung. Our findings suggest that changes in ECM nanoscale organization take place at different stages of fibrosis, with the potential to help identify pharmacological targets to hinder its progression.

DISGUISED INGUINAL HERNIA

Introduction

Liposarcomas are malignant neoplasms that originate in fatty mesenchymal tissue and are the most common histological subtype of soft tissue sarcomas. They account for 1% of solid tumors in adults and are located mainly in the extremities, with the retroperitoneum being the second most frequent location. Given the rarity and aggressiveness of these tumors, it is advisable to establish a multidisciplinary approach towards them in order to improve the prognosis of patients.

Clinical case

Patient who was operated upon on a scheduled and outpatient basis for a left inguinal hernia. During surgery, a preperitoneal tumor was identified that was removed and revealed a high-grade dedifferentiated liposarcoma. In a second surgical act, a tumor mass of about 10 centimeters in length was found, lodged in the left pelvis and contacting sigma, which extended into the inguinal duct and scrotal pouch. Finally, compartment surgery and a left orchiectomy with end-to-end colo-sigmoid anastomosis were performed.

Discussion

Routine examination of the masses contained in the hernial sacs is recommended since, despite their infrequency (&lt;0.1%), cases of liposarcomas that have their origin in the inguinal canal have been described. Surgery for retroperitoneal sarcomas must be compartmental, which requires the inclusion of viscera close to the tumor in the resection. Complete surgical resection R0 is the only potentially curative treatment. Compartment surgery should be performed by expert surgeons in referral centers with multidisciplinary teams to improve the prognosis of these patients.

HEMORRHOIDS AGAIN?

Introduction

Anal cancer represents 4% of digestive tract tumors, although its incidence is increasing due to the growing number of patients with HPV infection, who are immunosuppressed or who practice anal sex. The most common histological type is carcinoma and the usual standard treatment is the combination of radiotherapy with chemotherapy. Survival at 5 years exceeds 50% even in patients with nodal disease.

Clinical case

We present the case of a 54-year-old man, with a history of anal intercourse, referred to General Surgery for hemorrhoids. During the examination in consultation, an ulcerated excrescent anal lesion was observed. A rectal swab was taken for sexually transmitted diseases and a biopsy of the lesion was HPV+, genotype 16. In the pathology study, anal squamous cell carcinoma was diagnosed. An extension study was performed, objectifying bilateral inguinal lymphadenopathies (N1a) and treatment with radiochemotherapy was started after a decision made by the multidisciplinary tumor committee.

Discussion

Anal squamous cell carcinoma is the most frequent histological variety of malignant tumors of the anus. The first-line treatment is radiotherapy (which must be to the inguinal region) associated with chemotherapy (5-FU and mitomycin C). A clinical follow-up should be carried out in all cases at 8–12 weeks and, in addition, an annual extension radiological study in locally advanced cases. Rescue surgery will be reserved for those patients with confirmed locoregional recurrence, with abdominoperineal amputation being the indicated technique in most cases.

Measurement of vegetations in infective endocarditis: An inaccurate method to decide the therapeutical approach

BACKGROUND

The European Society of Cardiology and American Heart Association guidelines give a central role to the maximal vegetation diameter in the indication for surgery to prevent embolism in left sided infective endocarditis. Vegetation measuring is likely to be inaccurate. The hypothesis herein, is that the vegetation diameter is not an appropriate surgical criterion given the variability of its measurement.

METHODS

Two trained echocardiographers independently measured the maximal vegetation diameter by transesophageal echocardiogram of 76 vegetations in 67 consecutive patients with definite infective endocarditis in an off-line workstation. The interobserver variability was calculated by the interclass correlation coefficient. The relationship between the strength of agreement for the cut-off points of 10 and 15 mm was also calculated. Finally, the number of patients whose surgical indication would have changed depending on which operator measured the vegetation was evaluated.

RESULTS

Interobserver interclass correlation coefficient in the measurement of the maximal longitudinal diameter of the vegetations was 0.757 (0.642-0.839). The strength of agreement of the interobserver analysis for the cut-off point of 10 mm was 0.533 (0.327-0.759). For the cut-off point of 15 mm it was 0.475 (0.270-0.679). If heart failure or uncontrolled infections had been absent, the surgical indication would have changed in a total of 33 patients (33/76; 43%) depending on which operator measured the vegetation.

CONCLUSIONS

The variability in the measurements of the maximal longitudinal diameter by transesophageal echocardiogram is high. Surgical indications based on the cut-off points recommended by the international guidelines should be revised.

Frailty and prognosis of older patients with chronic heart failure

INTRODUCTION AND OBJECTIVES

Heart failure (HF) is prevalent in advanced ages. Our objective was to assess the impact of frailty on 1-year mortality in older patients with ambulatory HF.

METHODS

Our data come from the FRAGIC study (Spanish acronym for "Study of the impact of frailty and other geriatric syndromes on the clinical management and prognosis of elderly outpatients with heart failure"), a multicenter prospective registry conducted in 16 Spanish hospitals including outpatients ≥ 75 years with HF followed up by cardiology services in Spain.

RESULTS

We included 499 patients with a mean age of 81.4±4.3 years, of whom 193 (38%) were women. A total of 268 (54%) had left ventricular ejection fraction <40%, and 84.6% was in NYHA II functional class. The FRAIL scale identified 244 (49%) pre-frail and 111 (22%) frail patients. Frail patients were significantly older, were more frequently female (both, P <.001), and had higher comorbidity according to the Charlson index (P=.017) and a higher prevalence of geriatric syndromes (P <.001). During a median follow-up of 371 [361-387] days, 58 patients (11.6%) died. On multivariate analysis (Cox regression model), frailty detected with the FRAIL scale was marginally associated with mortality (HR=2.35; 95%CI, 0.96-5.71; P=.059), while frailty identified by the visual mobility scale was an independent predictor of mortality (HR=2.26; 95%CI, 1.16-4.38; P=.015); this association was maintained after adjustment for confounding variables (HR=2.13; 95%CI, 1.08-4.20; P=.02).

CONCLUSIONS

In elderly outpatients with HF, frailty is independently associated with mortality at 1 year of follow-up. It is essential to identify frailty as part of the comprehensive approach to elderly patients with HF.

Mining minerals and critical raw materials from bittern: Understanding metal ions fate in saltwork ponds

Seawater represents a potential resource for raw materials extraction. Although NaCl is the most representative mineral extracted other valuable compounds such as Mg, Li, Sr, Rb and B and elements at trace level (Cs, Co, In, Sc, Ga and Ge) are also contained in this "liquid mine". Most of them are considered as Critical Raw Materials by the European Union. Solar saltworks, providing concentration factors of up-to 20 to 40, offer a perfect platform for the development of minerals and metal recovery schemes taking benefit of the concentration and purification achieved along the evaporation saltwork ponds. However, the geochemistry of these elements in this environment has not been yet thoroughly evaluated. Their knowledge could enable the deployment of technologies capable to achieve the recovery of valuable minerals. The high ionic strengths expected (0.5-7 mol/kg) and the chemical complexity of the solutions imply that only numerical geochemical codes, as PHREEQC, and the use of Pitzer model to estimate the activity coefficients of the different species in solution can be adopted to provide valuable description of the systems. In the present work, for the first time, PHREEQC Pitzer code database was extended to include the target minor and trace elements using Trapani saltworks (Sicily, Italy) as a case study system. The model was able to predict: i) the purity in halite and the major impurities contained, mainly Ca, Mg and sulphate species; ii) the fate of minor components as B, Sr, Cs, Co, Ge and Ga along the evaporation ponds. The results obtained pose a fundamental step in critical raw materials mining from seawater brine, for process intensification and combination with desalination.

A multidimensional approach to the resilience in older adults despite COVID-19

Researchers have mainly focused on aging risk factors and COVID-19 consequences. However, older adults have proved their ability to overcome adversities along their life. Resilience is a protective variable that dampens the impact of stress. Based on MacLeod’s et al. (2016) approach, we aimed to analyze the relationship between older adults’ resilience and COVID-19 related-stressors as well as their physical, mental, and social characteristics. Eight hundred eighty-nine people aged 60 and over participated in this study. Older participants, women, having better perceived health and not losing a loved one because of the virus were associated with more resilience. Moreover, higher levels of gratitude, personal growth, life purpose and lower levels of depression were associated with greater scores in resilience. This study offers a change of perspective in which aging is perceived from a positive viewpoint by focusing on easily accessible resources that may help older adults to cope with adverse situations.

Usefulness of implementing the OHIP-14 questionnaire to assess the impact of xerostomia and hyposalivation on quality of life in patients with primary Sjögren's syndrome

BACKGROUND

The aim of this study is to analyze if the results of the Oral Health Impact Profile-14 questionnaire (OHIP-14) in patients with primary Sjögren's syndrome (pSS) are correlated with salivary flow and level of xerostomia.

METHODS

This observational cross-sectional study was conducted in 61 patients (60 women, one man, mean age 57.64 [13.52]) diagnosed of pSS according to the American-European Criteria (2002). After recording demographic, medical and dental data (decayed-missing-filled teeth index [DMFT]), unstimulated (UWS) and stimulated (SWS) salivary flows were collected. Subsequently, UWS flow was categorized into two groups (<0.1 ml/min and ≥0.1 ml/min) and SWS into three groups (<0.1 ml/min, 0.1-0.7 ml/min and >0.7 ml/min). Patients also filled out a visual analog scale (VAS) for xerostomia and OHIP-14 for self-reported quality of life (QoL).

RESULTS

Data showed positive and significant correlation between OHIP-14 and xerostomia, based on VAS results (r = 0.52; p = 0.001). Furthermore, there was a negative correlation between UWS and OHIP-14 scores (r = -0.34; p = 0.006) and VAS for xerostomia (r = -0.22; p = 0.09). No significant correlation was found between SWS and OHIP-14 or VAS neither between DMFT and OHIP-14. When assessing the level of QoL by the UWS and SWS flow categories a significant association was found for UWS (p = 0.001) but not for SWS (p = 0.11). The OHIP-14 values were higher in the groups with lower salivary flow. The multiple linear regression to predict OHIP-14 only selected VAS for xerostomia as a statistically significant predictor.

CONCLUSIONS

Increased level of xerostomia and reduced UWS flow decrease oral health-related QoL in patients with pSS.

Lenalidomide-dexamethasone versus observation in high-risk smoldering myeloma after 12 years of median follow-up time: A randomized, open-label study

BACKGROUND

Smoldering multiple myeloma (SMM) is a heterogeneous disease in terms of progression to myeloma (MM), but its standard of care continues to be observation.

METHODS

The QuiRedex phase 3 trial initiated in 2007 included 119 high-risk patients with SMM randomized to treatment or observation. Treatment consisted of nine 4-week induction cycles (lenalidomide [Rd], 25 mg on days 1-21 plus dexamethasone, 20 mg on days 1-4 and 12-15), followed by maintenance (R, 10 mg on days 1-21) for up to 2 years. The primary end-point was time to progression (TTP) to myeloma based on per protocol population. Secondary end-points were overall survival (OS), response rate, and safety. An update of the trial after a long-term follow-up is presented here. This trial was registered with ClinicalTrials.gov (NCT00480363).

FINDINGS

After a median follow-up time of 12.5 years (range: 10.4-13.6), the median TTP to MM was 2.1 years in the observation arm and 9.5 years in the Rd arm (HR: 0.28, 95% CI: 0.18-0.44, p &lt; 0.0001). The median OS was 8.5 years in the abstention arm and not reached in the Rd group (HR: 0.57, 95% CI: 0.34-0.95, p = 0.032). Patients who progressed received optimized treatments according to the standards of care, and the OS from progression was comparable in both arms (p = 0.96).

INTERPRETATION

This analysis confirms that early treatment with Rd for high-risk SMM translates into a sustained benefit in both TTP and OS.

FUNDING

Pethema (Spanish Program for the Treatment of Hematologic Diseases), Spain.

Resilience Among Direct Care Staff in Nursing Homes: Validation of the CD-RISC2

OBJECTIVES

Caring for older adults is a demanding task. Some professionals may find themselves in complex situations for which they may not be prepared. However, the repercussions of these difficult experiences will depend on personal factors. Resilience acts as a buffer against difficulties and experiences. However, its study with first-line caregivers in nursing homes is limited. This study aimed to validate the Connor-Davidson Resilience Scale-2 (CD-RISC2), examine its psychometric properties, and analyze the variables associated with resilience (sociodemographic and professionals´ variables).

METHODS

312 nursing home professionals participated in the study. Besides the Connor-Davidson Resilience Scale-2, they answered questionnaires about good care, burnout, quality of life, person-centered care, and well-being.

RESULTS

The CD-RISC2 showed adequate reliability and test-retest reliability. Good support was found for convergent validity with perceived health, person-directed care, personal growth, life purpose, quality of life and good care, and for discriminant validity with burnout. Conclusions: To our knowledge, this is the first study that validates the CD-RISC2 Spanish version with front-line workers in nursing homes showing adequate psychometric properties.

CLINICAL IMPLICATIONS

An abbreviated, simpler, self-assessed version may be more useful than longer versions, especially with professionals with a heavy workload, such as direct care staff in nursing homes.

Contemporary comparison of infective endocarditis caused by Candida albicans and Candida parapsilosis: a cohort study

Among 1655 consecutive patients with infective endocarditis treated from 1998 to 2020 in three tertiary care centres, 16 were caused by Candida albicans (CAIE, n = 8) and Candida parapsilosis (CPIE, n = 8). Compared to CAIE, CPIE were more frequently community-acquired. Prosthetic valve involvement was remarkably more common among patients with CPIE. CPIE cases presented a higher rate of positive blood cultures at admission, persistently positive blood cultures after antifungals initiation and positive valve cultures. All patients but four underwent cardiac surgery. Urgent surgery was more frequently performed in CPIE. No differences regarding in-hospital mortality were documented, even after adjusting for therapeutic management.

Longitudinal Impact of the COVID-19 Pandemic on Older Adults' Wellbeing

Background

The COVID-19 pandemic is a major stressful life event. This pandemic is causing significant changes in older adults' daily life affecting their physical and mental health. Psychological wellbeing is a protective variable when facing adverse circumstances, like the COVID-19 pandemic. This study analyzes the impact of COVID-19 on older adults' psychological wellbeing (personal growth and purpose in life) over time.

Materials and Methods

One hundred ninety-two people over 60 years old participated in a longitudinal study. Data were collected in three time points: during the lockdown on March 2020, when the lockdown finished (4 months after baseline), and during the third wave (10 months after baseline). We used latent growth curve models to assess the linear longitudinal trajectories of psychological wellbeing.

Results

Older adults did not show worse psychological wellbeing over time. Age has a positive impact on purpose in life. Furthermore, being a male, worrying about adverse effects of COVID-19, family functioning, resilience, personal growth, and acceptance associated with purpose in life.

Discussion

These results suggest that despite the difficult circumstances experienced during the COVID-19 pandemic, older adults have used protective variables for their psychological wellbeing.

Burnout and Quality of Life in Professionals Working in Nursing Homes: The Moderating Effect of Stereotypes

Objective

This study aimed to analyse how stereotypes towards older people moderate the relationship between burnout and quality of life (QoL) of professionals working in nursing homes.

Method

A total of 312 professionals were asked to complete questionnaires of burnout Maslach Burnout Inventory quality of Life (QPL-35) and aging stereotypes (CENVE). The moderation effects were tested using linear regression models.

Results

A negative association was observed between burnout and QoL. It was also found a statistically significant moderator effect of the total score of stereotypes and the health stereotypes, besides a marginally statistically significant moderator effect for motivational stereotypes. The moderator effects were different for people with low and high negative stereotypes. QoL was more affected under conditions of high burnout, in which people with more negative stereotypes tended to present higher QoL than people with lower negative stereotypes.

Conclusion

Highly burned-out professionals in nursing homes may avoid their negative feelings projecting them to residents through stereotypes, as a way of coping with burnout and increasing their QoL. However, this mechanism is an “aggressive reaction” and may have negative effects for both the older adult and the professional. The comprehension of these variables is essential for developing adequate intervention programs.

Emotional distress among older adults during the COVID-19 outbreak: understanding the longitudinal psychological impact of the COVID-19 pandemic

BACKGROUND

Older adults have proven their ability to overcome adversities throughout their life. This study aims to assess the impact of the COVID-19 pandemic on older adults' psychological distress (anxiety and depression) over time.

METHODS

A community-dwelling Spaniard population (N = 192) completed a survey and reported on their sociodemographic characteristics, appraisal and personal resources. Older adults took part in a longitudinal online survey collected in April 2020 (during the lockdown restrictions) and at two subsequent time points 3 and 9 months after baseline (without lockdown restrictions and during the third wave of the pandemic respectively).

RESULTS

Older adults did not evidence higher emotional distress than during the initial lockdown. Furthermore, depression remained stable and anxiety significantly decreased. Results also suggest that some sociodemographic characteristics, appraisals and personal resources are relevant. Older participants showed less anxiety than younger ones. Furthermore, being a male, resilience, and acceptance were related with the decrease of anxiety. Otherwise, fear of the COVID-19 outbreak and depression were related with the increase of anxiety.

CONCLUSION

Older adults may adapt to the adverse pandemic impact by using more adaptive resources that reduce their distress. Efforts to ameliorate older adults' anxiety by focusing on older adults' personal resources should be considered.

Reassessment of vegetation size as a sole indication for surgery in left-sided infective endocarditis

BACKGROUND

Guidelines recommend surgery in left-sided infective endocarditis (LSIE) associated with large vegetations. Given that most patients who undergo surgery also have other indications (heart failure and/or uncontrolled infection), it is not settled whether surgery should be routinely recommended in patients with large vegetations but no other predictors of poor outcome.

METHODS

A total of 726 patients with definitive LSIE were included in our analysis. Mean age was 64.9 years, 61% were male. Multivariate analysis of all patients was performed to determine if vegetation size is related to death in LSIE. Then, patients were divided in two groups according to vegetation size: Group A (>10 mm, n=420) and group B (≤10 mm, n=306). Univariate and multivariate analyses of group A patients were carried out to identify the variables related to death in this group. Impact of surgery on mortality of group A patients without heart failure or uncontrolled local infection (n=139) was assessed.

RESULTS

Age, Staphylococcus aureus, perivalvular complications, heart failure, kidney failure and septic shock, but not vegetation size, were associated with death. Patients with large vegetations showed increased mortality (31.7% in group A vs 24.8% in group B, p=0.045). Group A had more valve rupture and valve regurgitation than group B, but heart failure (55% vs 53%, p=0.678), stroke (22% vs 17.0%, p=0.091), systemic embolism (39% vs 32%, p=0.074), perivalvular complication (28% vs 28%, p=0.865) or septic shock (15% vs 13%, p=0.288) were similar in both groups. In patients from group A without heart failure or uncontrolled infection mortality was similar with and without surgery (n=139; n=70 with surgery, n=69 without surgery; mortality 18.6% vs 11.6% respectively, p=0.251).

CONCLUSIONS

large vegetations identify patients with poor outcome in LSIE. However, surgery is not associated with a better prognosis in patients with large vegetations if they do not present with another predictor of poor outcome such as heart failure or uncontrolled infection. These findings challenge whether vegetation size alone should be an indication for surgery in LSIE.

Untargeted metabolomic study of HepG2 cells under the effect of Fucus vesiculosus aqueous extract

RATIONALE

Fucus vesiculosus has been described with potential to develop functional foods containing bioactive compounds against various diseases. However, more studies are needed to better understand its functioning and its previously reported bioactivities, mainly at the molecular level.

METHODS

An untargeted metabolomic study was performed to analyse HepG2 cells exposed to F. vesiculosus aqueous extract, rich in phlorotannins and peptides, during 24 h. This study was carried out using liquid chromatography combined with high-resolution tandem mass spectrometry.

RESULTS

This metabolomic study showed significant changes in HepG2 metabolites in the presence of the extract, standing out being the increased intensity of various fatty acid amides (oleamide, (Z)-eicos-11-enamide, linoleamide, palmitamide, dodecanamide and stearamide). This group of metabolites is reported in the literature with anticancer and hypocholesterolemic activity, bioactivities also described for F. vesiculosus. The extract induced, likewise, the expression of glutathione indicating its antioxidant effect.

CONCLUSIONS

This study demonstrated the potential of the compounds present in the F. vesiculosus aqueous extract for the development of natural drugs, nutraceuticals or dietary supplements, justified at the molecular level by changes in cell metabolites related to anticancer and hypocholesterolemic activity. The results here described, using an untargeted metabolomic approach, may contribute to a better understanding of algal behaviour, when used as food, in health-promoting effects.

Genetic Analysis of the Fatty Acid Profile in Gilthead Seabream (Sparus aurata L.)

Simple Summary

Humans require essential fatty acids in their diet and marine fish are a source of them, especially omega3 fatty acids that present high benefits on diverse vascular diseases and the immune system. Breeding programs in gilthead seabream usually include growth as the first criterion in the selection process of the fish. However, that could lead to fish with a higher fillet fat content and a fatty acid profile with a lower polyunsaturated fatty acids percentage. Fillet fat content and its fatty acids profile have been revealed as heritable traits. Therefore, further studies to go deeper in the selection process are advisable.

Abstract

The gilthead seabream is one of the most valuable species in the Mediterranean basin both for fisheries and aquaculture. Marine fish, such as gilthead seabream, are a source of n3 polyunsaturated fatty acids, highly appreciated for human food owing to their benefits on the cardiovascular and immune systems. The aim of the present study was to estimate heritability for fatty acid (FA) profile in fillet gilthead seabream to be considered as a strategy of a selective breeding program. Total of 399 fish, from a broodstock Mediterranean Sea, were analysed for growth, flesh composition and FA profile. Heritabilities for growth traits, and flesh composition (fat, protein, and moisture content) were medium. Heritability was moderate for 14:0, 16:0 and 18:1n9 and for sum of monounsaturated FA and n6/n3 ratio, and it was low for 20:1n11 and 22:6n3 and the ratio unsaturated/saturated FA. Breeding programs in gilthead seabream usually include growth as the first criterion in the selection process of the fish. However, other quality traits, such as fillet fat content and its fatty acids profile should be considered, since they are very important traits for the consumer, from a nutritional point of view and the benefits for the health.

Management of congenital and acquired airway pathologies in newborns by a cross-disciplinary committee at a third level hospital

INTRODUCTION

Neonatal airway examination through flexible/rigid bronchoscopy has proved to be useful in the presence of persistent stridor and extubation failure, as well as to assess complications following cardiac surgery. At our institution, these examinations are carried out by a pulmonologist, a neonatologist, an otorhinolaryngologist, and a pediatric surgeon from the pediatric airway committee, established in 2014.

OBJECTIVE

To analyze the airway examinations performed in neonates during their stay at the neonatology/neonatal intensive care unit since the airway committee was established.

MATERIAL AND METHODS

A retrospective study of the airway examinations conducted in neonates from 2015 to 2019 was carried out. Clinical and demographic data, number of examinations, indications, findings, and complications were collected. Results are presented as mean and standard deviation. Statistical significance was established at p < 0.05.

RESULTS

92 airway examinations were analyzed in 51 patients (54.9% of whom were female). 51% of the patients were premature. Extubation failure and persistent respiratory symptoms following successful extubation were the most frequent indications for airway examination (35.3%). Stratification by gestational age or weight at birth was not associated with an increased risk of pathological findings at examination (p > 0.05). The most frequent finding was vocal cord paralysis (n = 14; 27.5%). In 10 patients (19.6%), no pathological findings were observed.

CONCLUSION

Airway examination is useful in patients with stridor to identify vocal cord paralysis following extubation failure. It also allows congenital airway pathologies to be diagnosed and treated. The number of examinations with no pathological findings was similar to that reported in international series.

Interferons Are Pro-Inflammatory Cytokines in Sheared-Stressed Human Aortic Valve Endothelial Cells

Calcific aortic valve disease (CAVD) is an athero-inflammatory process. Growing evidence supports the inflammation-driven calcification model, mediated by cytokines such as interferons (IFNs) and tumor necrosis factor (TNF)-α. Our goal was investigating IFNs' effects in human aortic valve endothelial cells (VEC) and the potential differences between aortic (aVEC) and ventricular (vVEC) side cells. The endothelial phenotype was analyzed by Western blot, qPCR, ELISA, monocyte adhesion, and migration assays. In mixed VEC populations, IFNs promoted the activation of signal transducers and activators of transcription-1 and nuclear factor-κB, and the subsequent up-regulation of pro-inflammatory molecules. Side-specific VEC were activated with IFN-γ and TNF-α in an orbital shaker flow system. TNF-α, but not IFN-γ, induced hypoxia-inducible factor (HIF)-1α stabilization or endothelial nitric oxide synthase downregulation. Additionally, IFN-γ inhibited TNF-α-induced migration of aVEC. Also, IFN-γ triggered cytokine secretion and adhesion molecule expression in aVEC and vVEC. Finally, aVEC were more prone to cytokine-mediated monocyte adhesion under multiaxial flow conditions as compared with uniaxial flow. In conclusion, IFNs promote inflammation and reduce TNF-α-mediated migration in human VEC. Moreover, monocyte adhesion was higher in inflamed aVEC sheared under multiaxial flow, which may be relevant to understanding the initial stages of CAVD.

COVID-19 pandemic lockdown responses from an emotional perspective: Family function as a differential pattern among older adults

Family can be an essential resource at times of loss or vital crisis. Loneliness and isolation in older adults might have serious negative consequences for their mental health. For this reason, this research aims to analyze the role of family function in the anxiety and depression experienced by older adults during the pandemic caused by COVID-19. Participants were 882 Spanish community-dwelling adults over 60 years of age. Sociodemographic characteristics, characteristics related to the coronavirus, self-perceived health, family function, avoidance, depression, and anxiety were analyzed. Data suggest a buffering effect of family function on anxiety and depression during the pandemic. Furthermore, being unmarried or a female, greater fear of COVID-19, worse self-perceived health, greater avoidance, and worse family function were associated with higher levels of anxiety. Likewise, greater fear of COVID-19, poorer self-perceived health, greater avoidance, and poorer family function, were associated with greater depression. These results point out that family dysfunction is a predisposing factor for the development of the emotional problems of anxiety and depression in older people in potentially stressful and loss situations.

Older People's Personal Strengths During the First Wave of the COVID-19 Pandemic

BACKGROUND

Although several biopsychosocial variables could play an important role as risk and protective factors of mental health, COVID-19 outbreak studies among older people have seldom focused on protective factors. The purpose of this study was to analyze how older adults' personal strengths predict their well-being and emotional distress.

METHOD

783 Spanish people aged 60 and over completed a survey that included sociodemographic characteristics, perceived health, direct or indirect infection by COVID-19, resilience, gratitude, experiential avoidance, family functioning, emotional distress and well-being. Structural Equation Modelling (SEM) was performed. SEM invariance was also used to analyze whether there were differences between older people affected by COVID-19 and those not affected.

RESULTS

The best model supports the mediation effect of resilience, gratitude and experiential avoidance on older people's well-being and emotional distress. Whether participants or relatives had been infected by the virus or not did not affect the results.

CONCLUSIONS

Variables used as criteria in older adults are related to well-being and emotional distress, but only indirectly and mediated by resilience, gratitude and experiential avoidance. This confirms the importance of considering psychological strengths in older people's well-being. Interventions focused on these personal resources should be considered.

Integration of membrane distillation as volume reduction technology for in-land desalination brines management: Pre-treatments and scaling limitations

Management of in-land reverse osmosis (RO) desalination brines generated from surface brackish waters is a current challenge. Among the different near-Zero and Zero Liquid Discharge (ZLD) alternatives, Membrane Distillation (MD), in which the transport of water is thermally driven, appears as an attractive technology if a residual heat source is available. The aim of this study was to identify the limits of Direct Contact MD (DCMD) pre-treatments such as acidification and aeration, or the combination of both to quantify the scaling reduction potential when treating a RO brine from surface brackish water. Experimental data were used to evaluate the effectiveness of DCMD to achieve the highest concentration factors, depending on the chosen pre-treatment. Additionally, an economic analysis of the operational cost, taking as case study a site where the current management of the brine is the discharge to the sea, was also carried out. Results showed that pre-treatments enhanced MD performance by increasing the concentration factor achieved and highest volume reductions (about 3 times) were reached with the combination of acidification and aeration pre-treatments. Both processes reduced the precipitation potential of CaCO₃(s) by reducing the total inorganic carbon (>90%); however, CaSO₄·2H₂O(s) precipitated. Results also indicated that even if a waste heat source is available, brine disposal into the sea is the cheapest option, while ZLD alternatives were not attractive in the current regulatory framework since their cost was higher than the discharge to the sea. Other options related to the Minimal Liquid Discharge may be more economically attractive.

Clinically used JAK inhibitor blunts dsRNA-induced inflammation and calcification in aortic valve interstitial cells

Calcific aortic valve disease (CAVD) is the most prevalent valvulopathy worldwide. Growing evidence supports a role for viral and cell-derived double-stranded (ds)-RNA in cardiovascular pathophysiology. Poly(I:C), a dsRNA surrogate, has been shown to induce inflammation, type I interferon (IFN) responses, and osteogenesis through Toll-like receptor 3 in aortic valve interstitial cells (VIC). Here, we aimed to determine whether IFN signaling via Janus kinase (JAK)/Signal transducers and activators of transcription (STAT) mediates dsRNA-induced responses in primary human VIC. Western blot, ELISA, qPCR, calcification, flow cytometry, and enzymatic assays were performed to evaluate the mechanisms of dsRNA-induced inflammation and calcification. Poly(I:C) triggered a type I IFN response characterized by IFN-regulatory factors gene upregulation, IFN-β secretion, and STAT1 activation. Additionally, Poly(I:C) promoted VIC inflammation via NF-κB and subsequent adhesion molecule expression, and cytokine secretion. Pretreatment with ruxolitinib, a clinically used JAK inhibitor, abrogated these responses. Moreover, Poly(I:C) promoted a pro-osteogenic phenotype and increased VIC calcification to a higher extent in cells from males. Inhibition of JAK with ruxolitinib or a type I IFN receptor blocking antibody blunted Poly(I:C)-induced calcification. Mechanistically, Poly(I:C) promoted VIC apoptosis in calcification medium, which was inhibited by ruxolitinib. Moreover, Poly(I:C) co-operated with IFN-γ to increase VIC calcification by synergistically activating extracellular signal-regulated kinases and hypoxia-inducible factor-1α pathways. In conclusion, JAK/STAT signaling mediates dsRNA-triggered inflammation, apoptosis, and calcification and may contribute to a positive autocrine loop in human VIC in the presence of IFN-γ. Blockade of dsRNA responses with JAK inhibitors may be a promising therapeutic avenue for CAVD.

Validation of the professional good care scale in nursing homes (GCS-NH)

BACKGROUND

There is extensive concern about older people's care in institutions, especially recently in the past years. One of the reasons is linked to the cases of elder abuse, not only shown by academic and scientific sources, but also by social and mass media and their impact on public perception of the institutional setting. What is more, current COVID-19 pandemic consequences on older people have provoked alarm and worry especially about what is happening in institutions.

METHODS

The sample for this study consists of 286 staff working in nursing homes in Spain. This study aimed to assess the psychometric properties of the Professional Good Care Scale in Nursing Homes (GCS-NH).

RESULTS

Results of parallel analyses and exploratory factor analyses (EFAs) showed a four-factor model for the 32-item scale: humanization (9 items), non-infantilization (10 items), respect (7 items) and empowerment (6 items). Then, psychometric properties were tested analysing internal consistency (reliability) and convergent, divergent and criterion validity. High internal consistency (reliability) and different validity evidence were obtained for the total scores of the GCS-NH and its subscales. GCS-NH scores were also capable of detecting risk of probable institutional elder abuse.

CONCLUSIONS

Results show that this scale is an appropriate, valid, and reliable multidimensional instrument to evaluate good care in older institutionalized people by staff. Good care is an outcome of a complex construct in which a wide range of factors converge (staff, older people, and environmental characteristics). The GCS-NH has potential to be used as a multidimensional tool to assess good care.

Transcatheter Aortic Valve Replacement for Residual Lesion of the Aortic Valve Following "Healed" Infective Endocarditis

OBJECTIVES

This study aimed to evaluate the safety and mid-term efficacy of transcatheter aortic valve replacement (TAVR) in the setting of aortic valve (AV) infective endocarditis (IE) with residual lesion despite successful antibiotic treatment.

BACKGROUND

Patients with AV-IE presenting residual lesion despite successful antibiotic treatment are often rejected for cardiac surgery due to high-risk. The use of TAVR following IE is not recommended.

METHODS

This was a multicenter retrospective study across 10 centers, gathering baseline, in-hospital, and 1-year follow-up characteristics of patients with healed AV-IE treated with TAVR. Matched comparison according to sex, EuroSCORE, chronic kidney disease, left ventricular function, prosthesis type, and valve-in-valve procedure was performed with a cohort of patients free of prior IE treated with TAVR (46 pairs).

RESULTS

Among 2,920 patients treated with TAVR, 54 (1.8%) presented with prior AV-IE with residual valvular lesion and healed infection. They had a higher rate of multivalvular disease and greater surgical risk scores. A previous valvular prosthesis was more frequent than a native valve (50% vs. 7.5%; p < 0.001). The in-hospital and 1-year mortality rates were 5.6% and 11.1%, respectively, comparable to the control cohort. After matching, the 1-year III to IV aortic regurgitation rate was 27.9% (vs. 10%; p = 0.08) and was independently associated with higher mortality. There was only 1 case of IE relapse (1.8%); however, 18% of patients were complicated with sepsis, and 43% were readmitted due to heart failure.

CONCLUSIONS

TAVR is a safe therapeutic alternative for residual valvular lesion after successfully healed AV-IE. At 1-year follow-up, the risk of IE relapse was low and mortality rate did not differ from TAVR patients free of prior IE, but one-fourth presented with significant aortic regurgitation and >50% required re-admission.

Valorisation options for Zn and Cu recovery from metal influenced acid mine waters through selective precipitation and ion-exchange processes: promotion of on-site/off-site management options

Acid mine waters (AMWs), generated in the processing of polymetallic sulphides, contain copper and zinc as the main valuable transition metal ions, which are typically removed by liming, due to their great environmental impact. In this context, this work proposes the integration of selective precipitation (SP) and ion-exchange (IX) processes for the separation and recovery of both valuable metals to encourage on-site and off-site management options promoting valorisation routes. Thus, the main objectives of this work were (i) the selective removal of Fe(III) and Al(III), using NaOH under pH control (pH < 5) to avoid the precipitation of Cu(II) and Zn(II) and (ii) the evaluation of a solvent-impregnated resin (Lewatit VP OC 1026, named VP1026) and a cation IX resin (Lewatit TP 207, named TP207) for the sequential extraction of both metal ions from AMW (batch and column experiments). Results indicated that the metallic pollution load was mostly removed during the SP process of Fe(III) (>99%) and Al(III) (>90%) as hydroxylsulphates (e.g., schwertmannite and basaluminite). The metal extraction profiles were determined for both metals from pH 1 to pH 5 by batch experiments, and indicated that the best extraction of Zn(II) was obtained using VP1026, being higher than 96% (pH = 2.6-2.8), whereas TP207 extraction performance was optimal for Cu(II) extraction (>99%) at pH = 3-4. Moreover, in dynamic experiments using a fixed-bed configuration, it was possible to separate and concentrate Zn(II) (concentration factor = 10) and Cu(II) (concentration factor = 40) using VP1026 and TP207, respectively. Overall, the integration of SP and IX processes showed a great potential in the separation and recovery of valuable metals from mine waters to promote a circular economy, based on the management proposal for non-ferrous metallurgical industries. The recovered Zn-rich and Cu-rich sulphuric concentrated streams were theoretically evaluated for further on-site or off-site re-use treatments (e.g., electrowinning, precipitation, crystallization).

Infective endocarditis in patients with aortic grafts

BACKGROUND

Infective endocarditis (IE) in patients with a valve-tube ascending aortic graft (AAG) is a rare entity with a challenging diagnosis and treatment. This study describes the clinical features, diagnosis and outcome of these patients.

METHODS

Between 1996 and 2019, 1654 episodes of IE were recruited in 3 centres, of which 37 patients (2.2%) had prosthetic aortic valve and AAG-IE (21 composite valve graft, 16 supracoronary graft) and conformed our study group.

RESULTS

Patients with aortic grafts were predominantly male (91.9%) and the mean age was 67.7 years. Staphylococci were the most frequently isolated microorganisms (32%). Viridans group streptococci were only isolated in patients with composite valve graft. TEE was positive in 89.2%. PET/CT was positive in all 15 patients in whom it was performed. Surgical treatment was performed in 62.2% of patients. In-hospital mortality was 16.2%. Heart failure and the type of infected graft (supracoronary aortic graft) were associated with mortality. Mortality among operated patients was 21.7%. Interestingly, 14 patients received antibiotic therapy alone, and only one died. Mortality was lower among patients with a composite valve graft compared to those with a supracoronary graft (4.8% vs 31.3%; p = 0.03).

CONCLUSIONS

In patients with AAG and prosthetic aortic valve IE, mortality is not higher than in other patients with prosthetic IE. Multimodality imaging plays an important role in the diagnosis and management of these patients. Heart failure and the type of surgery were risk factors associated with in-hospital mortality. Although surgical treatment is usually recommended, a conservative management might be a valid alternative treatment in selected patients.

Arsenic impact on the valorisation schemes of acidic mine waters of the Iberian Pyrite Belt: Integration of selective precipitation and spiral-wound nanofiltration processes

Arsenic and selenium presence in acid mine waters (AMWs) limits their disposal due to environmental regulations. The focus to solve the economic infeasibility is directed to sustainable solutions, promoting resource recovery. In fact, rare earth elements (REEs) recovery is proposed in most of the Iberian Pyrite Belt AMWs. However, the presence of arsenic and selenium may impact in the REEs recovery. Among different alternatives, nanofiltration (NF) provides a concentration stage on REEs recovery, reduces the nominal flow and removes hazardous species. In this work, Iberian Pyrite Belt AMWs with up to 10 mg/L REEs, containing arsenic (2 mg/L), were treated with a NF membrane. Firstly, AMWs were pre-treated with H₂O₂/NaOH, to oxidise Fe(II) to Fe(II) and As(III) to As(V), promoting their removal and avoiding their potential precipitation at the membrane. Subsequently, NF pressure effect (6-20 bar) was studied, removing metals (>95 %), whereas arsenic rejections ranged from 60 to 71 %. Then, water recovery potential was evaluated at 10, 15 and 22 bar by reproducing a 10-stages NF plant. Results showed that the proposed treatment could be an alternative for arsenic and selenium removal (70 μg/L and 0.5 μg/L permeate concentrations, respectively) to achieve mining discharge limits according to regulations.

Balneotherapy with a psychoeducation program for the promotion of a balanced care in family caregivers of older adults

This study aimed to analyze the efficacy of an intervention program for informal caregivers of elderly dependent that combined balneotherapy with group psychoeducation (BT-PE) based on the balanced care model. The BT-PE intervention (N = 124) was compared with a comparison group only exposed to balneotherapy (BT) (N = 76). The two modalities included both primary and secondary informal caregivers. A three-way mixed ANOVA was conducted to determine the effects of two between-subjects´ factors (intervention group and caregiver type) and one within-subjects´ factor (time) on burden, depression, anxiety, maladjustment and care satisfaction. Results showed less burden and more care satisfaction in both primary and secondary caregivers participating in the BT-PE program after the interventions. Primary caregivers also showed lower levels of maladjustment in the experimental group at post-intervention. Although depressive symptoms and anxiety decreased significantly in both intervention groups, BT-PE did not show lower scores compared with the application of sole BT. The relevance of caregivers´ psychoeducation on the balanced care model and its combination with balneotherapy is highlighted.

USEFULNESS OF PERIPHERAL BLOOD MONOCYTE COUNT TO PREDICT RELAPSE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A PROSPECTIVE LONGITUDINAL COHORT STUDY

Monocytes play an important role in the pathogenesis of inflammatory bowel disease but data are scarce as a biomarker of activity, above all, in patients under biologic therapies. The aim was to evaluate the value of monocyte measurements in predicting flares in inflammatory bowel disease patients under maintenance treatment with anti-TNF. A prospective, observational cohort study was designed. Relapse was defined as a Harvey-Bradshaw score >4 in Crohn's disease and a partial Mayo score ≥2 in ulcerative colitis. Monocytes concentration was quantified at 4-month intervals for twelve months. 95 consecutive patients were included. The median age was 42 years, 50.5% female and 75% with Crohn's disease. 65 (68.4%) patients remained in clinical remission. Mean monocyte concentration preceding the relapse was 563 (standard deviation 144) compared to 405 (standard deviation 177) in patients who kept in remission. Final monocytes concentration significantly differentiated between relapse and remission in Crohn's disease (AUC 0.82; 95% CI: 0.71-0.90; P <0.005). In the multivariate analysis, only monocytes and fecal calprotectin related to more relapses. In conclusion, in inflammatory bowel disease patients under anti-TNF therapy, repeated monocytes concentration could help in order to monitoring patients, at least, in Crohn's disease.

The role of acceptance in parents whose child suffers from cancer

OBJECTIVE

Parents are the main caregivers when there is a child diagnosed with cancer. Receiving a diagnosis of childhood cancer is a stressful experience. The objective of this study is to explore the mediating role of emotional avoidance and acceptance in the emotional adjustment of parents throughout the disease.

METHODS

Using the qualitative methodology Interpretative Phenomenological Analysis (IPA), parent's experiences of having a child with a diagnosis of cancer were explicated. Participants (n = 10) took part in one-on-one semi-structured interviews.

RESULTS

Acceptance serves to cope with paediatric cancer because parents live day by day, actively taking care of their children. Acceptance and emotional avoidance with oneself, with the sick child and with the others play a key role in emotional adjustment. Differences between acceptance and avoidance were considered.

CONCLUSION

Three main themes emerged from the analyses. Parents' ability to overcome their emotional struggle provides a non-pathological view of the experience of a child's illness. The results also showed the possibility for parents to access new ways to support their loved ones and to maintain the quality of their relationships. Acceptance has a positive impact on parents' adjustment while avoidance showed a negative effect on parents of children with cancer.