Effectiveness of thromboprophylaxis with low molecular weight heparin in critically ill patients with COVID-19. An observational prospective, multicenter study

INTRODUCTION

COVID-19 induces coagulopathy associated with an increase of thromboembolic events. Due to the lack of agreement on recommendations for thromboprophylactic management, the aim of this study was to study the dosages of LMWH used in critically ill COVID-19 patients assessing the effect on their outcome.

METHODS

We evaluated data of the Reg-COVID19. According to LMWH dose two groups were analyzed: prophylaxis and treatment. Primary outcome was the relationship of LMWH dosage with mortality. Secondary outcomes included the incidence of thrombotic and bleeding events, length of ICU stay, invasive mechanical ventilation, and thrombotic and inflammatory parameters.

RESULTS

Data of 720 patients were analyzed, 258 in the prophylaxis group and 462 in the treatment group. C Reactive Protein, invasive mechanical ventilation, tocilizumab and corticosteroid treatments were related with the choice of LMWH dose. Hemorrhagic events (66/720, 9.2%) and thrombotic complications (69/720, 9.6%) were similar in both groups (p = .819 and p = .265), as was the time course of the thrombotic events, earlier than hemorrhagic ones (9 [3-18] and 12 [6-19] days respectively). Mortality was lower in prophylaxis group (25.2% versus 35.1%), but once an inverse probability weighting model was applied, we found no effect of LMWH dose.

CONCLUSION

We found no benefit or harm with the administration of therapeutic or prophylactic LMWH dose in COVID19 critically ill patients. With a similar rate of hemorrhagic or thrombotic events, the LMWH dose had no influence on mortality. More studies are needed to determine the optimal thromboprophylaxis protocol for critically ill patients.

[Effectiveness of thromboprophylaxis with low molecular weight heparin in critically ill patients with COVID-19. An observational prospective, multicenter study]

Introduction

COVID-19 induces coagulopathy associated with an increase of thromboembolic events. Due to the lack of agreement on recommendations for thromboprophylactic management, the aim of this study was to study the dosages of LMWH used in critically ill COVID-19 patients assessing the effect on their outcome.

Metohds

We evaluated data of the Reg-COVID19. According to LMWH dose two groups were analyzed: prophylaxis and treatment. Primary outcome was the relationship of LMWH dosage with mortality. Secondary outcomes included the incidence of thrombotic and bleeding events, length of ICU stay, invasive mechanical ventilation, and thrombotic and inflammatory parameters.

Results

Data of 720 patients were analyzed, 258 in the prophylaxis group and 462 in the treatment group. C Reactive Protein, invasive mechanical ventilation, tocilizumab and corticosteroid treatments were related with the choice of LMWH dose. Hemorrhagic events (66/720, 9.2%) and thrombotic complications (69/720, 9.6%) were similar in both groups (P=.819 and P=.265), as was the time course of the thrombotic events, earlier than hemorrhagic ones (9 [3-18] and 12 [6-19] days respectively). Mortality was lower in prophylaxis group (25.2% versus 35.1%), but once an inverse probability weighting model was applied, we found no effect of LMWH dose.

Conclusion

We found no benefit or harm with the administration of therapeutic or prophylactic LMWH dose in COVID19 critically ill patients. With a similar rate of hemorrhagic or thrombotic events, the LMWH dose had no influence on mortality. More studies are needed to determine the optimal thromboprophylaxis protocol for critically ill patients.

[Cognitive impairment in the elderly patient with symptomatic severe aortic stenosis. Therapeutic decisions and impact on one-year mortality]

INTRODUCTION

Interventional treatment of severe aortic stenosis includes valve replacement by surgery or transcatheter - transcatheter aortic valve implantation (TAVI). In order to make an adequate selection and to rule out patients with little/no therapeutic benefit, it is recommended to assess comorbidities, frailty and cognitive impairment.

AIMS

a) To determine the prevalence of cognitive impairment in older patients with severe aortic stenosis; b) to analyse its influence on decision-making (surgery, TAVI or conservative treatment); and c) to analyse its impact on mortality at one year.

MATERIAL AND METHODS

Prospective, longitudinal epidemiological study of patients aged 75 years and older with severe aortic stenosis treated by the Heart-Team.

VARIABLES

sociodemographic, clinical, cardiological, functional and mental variables; cognitive impairment assessed by applying the Mini-Mental State Examination (MMSE).

RESULTS

We included 300 patients in the study (83.99 ± 4.02 years old; 61.2%, women). Prevalence of cognitive impairment of 15.3%, which was associated with albumin level - odds ratio (OR): 0.082; p = 0.011 - and Barthel (OR: 0.962; p = 0.02) and Lawton (OR: 0.787; p = 0.025) index scores. Surgery was chosen in 24.7% of cases; TAVI in 63.3%; and conservative treatment in 12%. This decision was associated with the score on the Barthel (OR: 0.93; p = 0.012) and Lawton indices (OR: 0.678; p = 0.014), the Short Physical Performance Battery (OR: 0.75; p = 0.037) and the MMSE (OR: 0.691; p < 0.001). Mortality at one year was 14%, and higher in patients with MMSE scores <24 (23.5% vs. 12.8%; p = 0.094).

CONCLUSIONS

Cognitive impairment is a very common geriatric syndrome in older patients with severe aortic stenosis that is associated with functional disability in activities of daily living. Cognitive impairment has a high impact on decision-making and appears to be a variable associated with increased mortality.

Search for Gamma-Ray Spectral Lines from Dark Matter Annihilation up to 100 TeV toward the Galactic Center with MAGIC

Linelike features in TeV γ rays constitute a "smoking gun" for TeV-scale particle dark matter and new physics. Probing the Galactic Center region with ground-based Cherenkov telescopes enables the search for TeV spectral features in immediate association with a dense dark matter reservoir at a sensitivity out of reach for satellite γ-ray detectors, and direct detection and collider experiments. We report on 223 hours of observations of the Galactic Center region with the MAGIC stereoscopic telescope system reaching γ-ray energies up to 100 TeV. We improved the sensitivity to spectral lines at high energies using large-zenith-angle observations and a novel background modeling method within a maximum-likelihood analysis in the energy domain. No linelike spectral feature is found in our analysis. Therefore, we constrain the cross section for dark matter annihilation into two photons to ⟨σv⟩≲5×10^{-28}  cm^{3} s^{-1} at 1 TeV and ⟨σv⟩≲1×10^{-25}  cm^{3} s^{-1} at 100 TeV, achieving the best limits to date for a dark matter mass above 20 TeV and a cuspy dark matter profile at the Galactic Center. Finally, we use the derived limits for both cuspy and cored dark matter profiles to constrain supersymmetric wino models.

Influence of the energy concentration and the standardized ileal digestible lysine content of the diet on performance and egg quality of brown-egg laying hens from 18 to 41 weeks of age

The influence of the energy and the standardized ileal digestible lysine (DLys) content of the diet on egg production and egg quality, was studied in brown-egg laying hens from 18 to 41 wk of age. The experimental design was completely randomized with 10 treatments organized as a 2 × 5 factorial with 2 energy concentrations (2,750 and 2,800 kcal AMEn/kg) and 5 levels of DLys (values varied from 0.66 to 0.78% and 0.67 to 0.79%, for the low and high energy diets, respectively). Each treatment was replicated 10 times (10 hens per replicate). The data were analyzed using the MIXED procedure of SAS with energy concentration and DLys content of the diets as main effects. In addition, the effects of the DLys on the variables studied were partitioned into its lineal and quadratic components. From 18 to 21 wk of age (pre-peak phase), diet composition had limited effects on egg production. From 22 to 41 wk of age (peak phase), however, an increase of 50 kcal AMEn/kg diet increased egg weight (P < 0.05) and tended to improve energy intake (P = 0.083) and feed conversion ratio (P = 0.074). An increase in DLys improved linearly (P < 0.001) egg production, egg weight, egg mass, feed conversion, and energy conversion ratio, and tended to increase BW gain (P = 0.074). Diet composition did not any affect egg quality trait except shell strength that increased linearly (P < 0.05) with increases in the DLys. Cumulatively (18–41 wk of age), egg weight increased (P < 0.05) as the energy and the DLys content of the diet increased. In summary, an increase in energy and DLys content of the diet had limited effects on egg production during the prepeak phase but improved egg production, feed conversion ratio, and BW gain during the peak phase. The data indicate that hens require at least 839 mg DLys/d to maximize egg production in the peak production phase.

Spanish multicenter study of surgical resection of pancreatic tumors infiltrating the celiac axis: does the type of pancreatectomy affect results?

BACKGROUND

Pancreatectomy plus celiac axis resection (CAR) is performed in patients with locally advanced pancreatic cancer. The morbidity rates are high, and no survival benefit has been confirmed. It is not known at present whether it is the type of pancreatectomy, or CAR itself, that is the reason for the high complication rates.

METHODS

Observational retrospective multicenter study.

INCLUSION CRITERIA

patient undergoing TP, PD or DP plus CAR for a pancreatic cancer.

RESULTS

Sixty-two patients who had undergone pancreatic cancer surgery (PD,TP or DP) plus CAR were studied. Group 1: 17 patients who underwent PD/TP-CAR (13TP/4PD); group 2: 45 patients who underwent DP-CAR. Groups were mostly homogeneous. Operating time was longer in the PD/TP group, while operative complications did not differ statistically in the two groups. The number of lymph nodes removed was higher in the PD/TP group (26.5 vs 17.3), and this group also had a higher positive node ratio (17.9% vs 7.6%). There were no statistical differences in total or disease-free survival between the two groups.

CONCLUSION

It seems that CAR, and not the type of pancreatectomy, influences morbidity and mortality in this type of surgery. International multicenter studies with larger numbers of patients are now needed to validate the data presented here.

Bounds on Lorentz Invariance Violation from MAGIC Observation of GRB 190114C

On January 14, 2019, the Major Atmospheric Gamma Imaging Cherenkov telescopes detected GRB 190114C above 0.2 TeV, recording the most energetic photons ever observed from a gamma-ray burst. We use this unique observation to probe an energy dependence of the speed of light in vacuo for photons as predicted by several quantum gravity models. Based on a set of assumptions on the possible intrinsic spectral and temporal evolution, we obtain competitive lower limits on the quadratic leading order of speed of light modification.

Comparison of Proteomic Assessment Methods in Multiple Cohort Studies

Novel proteomics platforms, such as the aptamer-based SOMAscan platform, can quantify large numbers of proteins efficiently and cost-effectively and are rapidly growing in popularity. However, comparisons to conventional immunoassays remain underexplored, leaving investigators unsure when cross-assay comparisons are appropriate. The correlation of results from immunoassays with relative protein quantification is explored by SOMAscan. For 63 proteins assessed in two chronic obstructive pulmonary disease (COPD) cohorts, subpopulations and intermediate outcome measures in COPD Study (SPIROMICS), and COPDGene, using myriad rules based medicine multiplex immunoassays and SOMAscan, Spearman correlation coefficients range from -0.13 to 0.97, with a median correlation coefficient of ≈0.5 and consistent results across cohorts. A similar range is observed for immunoassays in the population-based Multi-Ethnic Study of Atherosclerosis and for other assays in COPDGene and SPIROMICS. Comparisons of relative quantification from the antibody-based Olink platform and SOMAscan in a small cohort of myocardial infarction patients also show a wide correlation range. Finally, cis pQTL data, mass spectrometry aptamer confirmation, and other publicly available data are integrated to assess relationships with observed correlations. Correlation between proteomics assays shows a wide range and should be carefully considered when comparing and meta-analyzing proteomics data across assays and studies.

Higher serum levels of systemic inflammatory markers are linked to greater inspiratory muscle dysfunction in COPD

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is associated with an inflammatory response that becomes more pronounced in acute exacerbations. Considerable attention has recently focused on the value of several inflammatory mediators in predicting worsening of COPD-related symptoms. Whereas respiratory muscle dysfunction is also widely present in this population, little is known about how systemic inflammation relates to inspiratory muscle dysfunction in COPD.

METHODS

Fifty-three males with mild-to-very severe airflow obstruction underwent blood sampling for 23 inflammatory markers, including acute-phase proteins, cytokines and adipokines. Inspiratory muscle performance was assessed via the test of incremental respiratory endurance, providing measures of maximal (MIP) and sustained maximal (SMIP) inspiratory pressures.

RESULTS

The mean ± SD MIP and SMIP were 75.32 ± 19.62 cmH₂ O and 406.15 ± 124.55 PTU. MIP negatively correlated with CRP, SAA and cystatin C (r-values from -0.333 to -0.378, P < 0.02), while SMIP was inversely related to SAA and cystatin C (r = -0.534 and r = -0.396, P = 0.00). Significant differences in CRP, SAA, cystatin C and PARC were also found between subjects with and without inspiratory muscle weakness. No additional significant relationships were observed between either MIP or SMIP and other inflammatory markers in the study.

CONCLUSIONS

MIP and SMIP are markedly reduced with greater degrees of inflammation in COPD as expressed by higher levels of CRP, SAA and cystatin C. Future research is needed to further examine the above findings and determine the impact of systemic inflammation along with its underlying mechanisms on inspiratory muscle function in COPD.

Influence of grinding size of the main cereal of the diet on egg production and eggs quality of brown egg laying hens from 33 to 65 weeks of age

The influence of grinding size of the main cereal of the diet on production and egg quality traits was studied in brown hens from 33 to 65 wk of age. The experiment was completely randomized with 6 treatments arranged as a 3 × 2 factorial with 3 main cereals (barley, corn, and wheat) and 2 grinding size of the cereal (6 and 10 mm screen). Each treatment was replicated 11 times (10 hens/replicate). Diets were isonutritive and contained 2,740 kcal/kg AMEn and 16.8% CP. Egg production, ADFI, egg weight, and feed conversion ratio (FCR) were determined by period (4 wk) and for the entire experiment. Egg quality traits (percentage of undergrades, Haugh units, thickness, strength, color of the shell, and proportion of albumen, yolk, and shell) were measured also by period. No interactions between main cereal and grinding size of the main cereal of the diet were observed for any of the traits studied. Feed intake, egg production, and BW gain were not affected by diet or grinding size. Eggs were heavier (P < 0.01) in hens fed barley than in hens fed corn or wheat, probably because of the higher fat content of the barley diets. Also, FCR tended to improve in hens fed barley compared with hens fed corn or wheat (P = 0.07). Diet did not affect any of the egg quality traits studied. In summary, barley and wheat conveniently supplemented with enzymes, can be used in substitution of corn at levels of up to 55% in diets for laying hens, without any adverse effect on egg production or egg quality traits. Moreover, the substitution of corn by a combination of barley and supplemental fat increased egg size. Consequently, the inclusion of one or other cereal in the diet will depend primarily on their relative cost. Within the range studied, screen size (6 vs. 10 mm) of the cereal had limited effects on hen production.

[Single nucleotide polymorphisms in genes of endothelin-1 and receptor A associated to cardiovascular in essential hypertension]

INTRODUCTION

The endothelin system, for its vasoconstrictor action, is related to the development of essential hypertension (HTAe). The polymorphism analysis of their genes represents a new approach to the study of this disease. We propose to analyze the interaction between stages of essential hypertension (HTAe) and risk factors with polymorphisms 138ex1 ins/del A gene endothelin-1 (ET-1) and H323H receptor gene A ET-1 (ETRA).

PATIENTS AND METHODS

We included 300 patients of both sexes, unrelated, who consecutively attended the clinic hypertension medical service. Each one underwent a complete physical examination, electrocardiogram, echocardiogram, and Rx thorax. The degree of severity of hypertension was determined in stages. The determination of polymorphisms was performed by amplification followed by cutting by specific restriction enzyme from DNA obtained from peripheral blood.

RESULTS

The 46% of patients had HTAe controlled, 17.6% had organ damage or cardiovascular, brain or kidney disease. It was observed that the 4A/4A carriers showed lower frequency of cardiovascular disease, kidney and brain (P<.032; 95% CI: 11.1-21.4). For H323H polymorphism, the evaluation by images showed a higher frequency of the dilations of left auricular (P=.02) and auricular fibrillation (P=.03) between the T/T carrier, a higher frequency of cardiomegaly was detected in C/C patients (P=.04).

CONCLUSION

The genotypes, 4A/4A of the ET-1 gene and the T/T from ETRA gene might be involved in worse outcome of cardiovascular damage. Their identification could help recognize subgroups of the hypertensive patients with different risk.

Efficacy and tolerability of two single-day regimens of triclabendazole for fascioliasis in Peruvian children

INTRODUCTION

The therapeutic scheme of triclabendazole (TCBZ), the recommended anthelmintic against Fasciola hepatica , involves 10mg/kg of body weight administered in a single dose; however, clinical trials in children are scarce. We evaluated the efficacy and tolerability of 2 schemes of TCBZ.

METHODS

Eighty-four Peruvian children with F. hepatica eggs in their stools were allocated into 2 groups: 44 received 2 dosages of 7.5mg/kg each with a 12-h interval (Group I), and 40 received a single 10-mg/kg dose (Group II). Evaluation of efficacy was based on the presence of eggs in stools, and tolerability was based on the presence of symptoms and signs post-treatment.

RESULTS

A parasitological cure was obtained in 100% of individuals from Group I and 95% of individuals from Group II. The most common adverse event was biliary colic.

CONCLUSIONS

The tested scheme was efficacious and tolerable, and it might be an optimal scheme in the region. To the best of our knowledge, this represents the largest series of children treated with TCBZ in a non-hospital setting.

A test of phenotypic selection on petal form in the wild carnation, Dianthus inoxianus

Floral phenotypes are considered a product of pollinator-mediated selection, which also has the side effect of decreasing floral variation within species. Correlates of flower visibility and function were studied in a carnation species (Dianthus inoxianus), which has crepuscular anthesis and scent-based pollination by the hawkmoth Hyles livornica. We also assessed constancy of flower form in nature and in cultivation and, using fruit set as an estimate of plant relative fitness, tested whether the main pollinator exerted phenotypic selection on floral traits. Petal claw, which is roughly equivalent to the average depth at which an insect's proboscis must be inserted to reach nectar, was remarkably constant among wild plants (coefficient of variation 8%). In contrast, the area of the visible part of the petal, and the intensity of a coloured dot pattern on the petal was very variable (respectively CV = 34% and 102%). Cultivation in a common environment revealed significant variation among genotypes as regards petal area, degree of laciniation and extension of the dot pattern, but not petal claw length, which remained steady. Petal area, shape and colour did not affect relative fitness during the year of study, but plants with intermediate petal claws (i.e. floral tubes) set significantly more fruit. Results are compatible with low response of the main pollinator to variation in visual traits (petal area, laciniation, colour) and high responsiveness to variation in other aspects (tube length). Inconsistent phenotypic selection by pollinators may add to other causes of floral variation in the genus Dianthus, the causes of which are discussed.

Use of a temporary inferior vena cava filter during pregnancy in patients with thromboembolic events

There are circumstances in the management of thromboembolic events during pregnancy when anticoagulant therapy is either contraindicated or not advisable, such as when pulmonary embolism (PE) or deep venous thrombosis is diagnosed close to term, given the risk of bleeding during delivery. In these cases, the thromboembolic risk can be controlled using temporary inferior vena cava filters (T-IVCFs). We present the case of a pregnant woman with thrombophilia who remained at rest for eight weeks due to an amniotic prolapse and for whom the placement of a T-IVCF was decided at 32 weeks' gestation after anticoagulant therapy had failed. An emergency caesarean section was performed at 33 weeks' gestation due to placental abruption following the spontaneous onset of preterm labour. The risk of bleeding during delivery when high doses of heparin are used, and the risk of PE when the heparin dose is decreased, needs to be evaluated versus the risks related to T-IVCF placement procedure and, as such, a review of the published experience in this field is warranted. We have concluded that T-IVCFs can be a safe alternative treatment for pregnant women in whom anticoagulation therapy is either contraindicated or not advisable.

Beta-blockers use for hypertension in the elderly

Beta-blockers are considered as suitable drugs to treat essential hypertension also in elderly patients and they are currently recommended for treatment of hypertension, even in older patients, by the ESH/ESC Guidelines. Different meta-analyses and results of some large clinical trials have shown that here is no clinically difference between β-blockers and other drug classes in decreasing high blood pressure in elderly hypertensive patients. The new vasodilating β-blockers, as nebivolol, carvedilol and celiprolol, offer additional important advantages, compared with traditional β-blockers. The cardio-protective effect of β-blockers (except atenolol) is not inferior to that obtained with other drug classes which is independent of age and gender of the patients.

[Calcaneus fractures as a complication of the percutaneous treatment of plantar fasciitis. Case report]

Plantar fasciitis, a self-limiting pathologic entity, is a common cause of heel pain in adult patients. Surgical treatment is indicated when the patient does not improve after receiving conservative treatment for 4-6 months with proper surveillance. The complications of percutaneous techniques include: infection, persistent pain, and neurologic injuries, among others. We report the case of a patient with calcaneus fracture following percutaneous plantar fasciotomy and resection of a calcaneal spur. We conducted a review and discussion of the literature.

Erythropoiesis stimulating agents (ESAs) for congestive heart failure: the red and the black

CHF is a disease of high incidence and prevalence in the elderly. Anemia is associated with an increased mortality in these patients. Erythropoietin secretion is reduced in these patients due to complexed mechanisms. Although some improvement in quality of life has been shown when using ESAs it has not been found any decrement on mortality. Moreover, safety reports suggest an increased risk of thromboembolic event. Together with the high drug cost, the use of ESAs cannot be recommended for the treatment of CHF patients.

Abstract C202: Probing EGFR, HER2 and c-Met protein-protein interactions using an antibody array

The receptor tyrosine kinase (RTK) family comprises important disease drivers and validated drug targets. Cooperation between certain RTKs is often achieved through physical interactions and is thought be a contributing factor to some cases of tumor resistance to targeted therapies. Epidermal Growth Factor Receptor (EGFR), HER2/ErbB2, and c-Met are prominent examples of disease driver RTKs that cooperate and form heterodimers. Current methods to detect RTK protein-protein interactions lack proper throughput, are not quantitative, or rely on highly engineered systems and cumbersome workflows. We have developed a planar surface antibody array-based sandwich assay that enables the detection and relative quantification of interactions between EGFR, HER2, and c-Met. The antibody-based assay revealed co-existing combinatorial receptor interactions that were unique to each cell type tested. The assay also pointed to an existence of distinct topological configurations of EGFR-c-Met and EGFR-HER2 heterodimers, unveiling previously not described nuances of these interactions. Lastly, the array-based assay allowed monitoring the disruption of receptor complexes using small molecule inhibitors and revealed differential sensitivity of EGFR-HER2 and EGFR-c-Met complexes to a small molecule EGFR kinase inhibitor, gefitinib. The antibody array sandwich assay described here allows utilizing larger panel of affinity reagents and can be applied to broader range of cases with various topological requirements, thus offering an advantage over technologies that have strict proximity requirement. This novel protein interaction array enables parallel detection of RTK protein-protein interactions, allowing a more systematic monitoring of response to activators or inhibitors.

Citation Information: Mol Cancer Ther 2013;12(11 Suppl):C202.

Citation Format: Jacob Knowles, Stephen Capodilupo, Richard Noring, Roberto Campos-González, Julio Herrera, Zev Gechtman. Probing EGFR, HER2 and c-Met protein-protein interactions using an antibody array. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr C202.

HyDRa: control of parameters for deterministic polishing

Deterministic hydrodynamic polishing with HyDRa requires a precise control of polishing parameters, such as propelling air pressure, slurry density, slurry flux and tool height. We describe the HyDRa polishing system and prove how precise, deterministic polishing can be achieved in terms of the control of these parameters. The polishing results of an 84 cm hyperbolic mirror are presented to illustrate how the stability of these parameters is important to obtain high-quality surfaces.

Primary empty sella (PES): a review of 175 cases

The term primary empty sella (PES) makes reference to the herniation of the subarachnoid space within the sella turcica in patients with no history of pituitary tumor, surgery or radiotherapy. To retrospectively assess clinical features, radiological findings and the biochemical endocrine function from the records of 175 patients with a diagnosis of PES. One hundred seventy-five patients (150 females) were studied. The mean age at diagnosis was 48.2 ± 14 year. Most diagnoses were made by magnetic resonance imaging (n = 172). In most patients, the pituitary function was assessed by basal pituitary hormones measurements. Pituitary scans were ordered for different reasons: headache (33.1 %), endocrine disorders (30.6 %), neurological symptoms (12.5 %), visual disturbances (8.75 %), abnormalities on sella turcica radiograph (8.75 %) and others (6.25 %). Multiple pregnancies were observed in 58.3 % of women; headaches, obesity, and hypertension were found in 59.4, 49.5, and 27.3 % of the studied population, respectively. Mild hyperprolactinemia (<50 ng/ml) was present in 11.6 % of women and 17.3 % of men. Twenty-eight percent of our patients had some degree of hypopituitarism. In the male population, hypopituitarism represented 64 % of cases, whereas it accounted for 22 % of all females. PES seems to be more commonly found in middle-aged women, with a history of multiple pregnancies. In most patients, PES was discovered as an incidental finding on imaging studies, while in almost a quarter of patients PES was found during the diagnostic evaluation of anterior pituitary deficiency, which was more common in men.

Andromonoecy in an Old World Papilionoid legume, Erophaca baetica

Andromonoecy (i.e. the occurrence on individual plants of hermaphroditic and male flowers) is a rare sexual system among the angiosperms, regarded by some authors as a transitional stage from hermaphroditism to monoecy. Having discovered the occurrence of andromonoecy in Erophaca baetica (a Mediterranean shrubby legume with two subspecies), a novelty for Old World papilionoid legumes, we investigated the morpho-functional correlates and the geographical distribution of this phenomenon in the species. The relative frequencies of hermaphrodite and male flowers were determined in two field and 111 herbarium populations. Biomass allocation within flowers, pollen production and viability, pollen tube growth, nectar production and the temporal pattern of male flower production were also studied in two nearby southern Spanish populations. Virtually all of the studied populations were andromonoecious. Male flowers tended to appear at apical positions within the inflorescence, and became more abundant by the end of the flowering season. Male flowers were externally similar to hermaphroditic flowers (although with less biomass and smaller parts) and released equivalent amounts of pollen and nectar; however, their pollen germinated significantly better. Erophaca is the first example of an andromonecious Papilionoid in the Old World. Since the main difference among floral morphs in this species is functional (i.e. pollen germination rate) rather than morphological, andromonoecy is not readily noticeable, and very careful inspection may be required to reveal it. The potential effect of andromonoecy in enhancing outcrossing rate in this species is discussed.

Silicon slow-light-based photonic mixer for microwave-frequency conversion applications

We describe and demonstrate experimentally a method for photonic mixing of microwave signals by using a silicon electro-optical Mach-Zehnder modulator enhanced via slow-light propagation. Slow light with a group index of ~11, achieved in a one-dimensional periodic structure, is exploited to improve the upconversion performance of an input frequency signal from 1 to 10.25 GHz. A minimum transmission point is used to successfully demonstrate the upconversion with very low conversion losses of ~7 dB and excellent quality of the received I/Q modulated QPSK signal with an optimum EVM of ~8%.

Using machine learning techniques and genomic/proteomic information from known databases for defining relevant features for PPI classification

In modern proteomics, prediction of protein-protein interactions (PPIs) is a key research line, as these interactions take part in most essential biological processes. In this paper, a new approach is proposed to PPI data classification based on the extraction of genomic and proteomic information from well-known databases and the incorporation of semantic measures. This approach is carried out through the application of data mining techniques and provides very accurate models with high levels of sensitivity and specificity in the classification of PPIs. The well-known support vector machine paradigm is used to learn the models, which will also return a new confidence score which may help expert researchers to filter out and validate new external PPIs. One of the most-widely analyzed organisms, yeast, will be studied. We processed a very high-confidence dataset by extracting up to 26 specific features obtained from the chosen databases, half of them calculated using two new similarity measures proposed in this paper. Then, by applying a filter-wrapper algorithm for feature selection, we obtained a final set composed of the eight most relevant features for predicting PPIs, which was validated by a ROC analysis. The prediction capability of the support vector machine model using these eight features was tested through the evaluation of the predictions obtained in a set of external experimental, computational, and literature-collected datasets.

On-line delay estimation for stable, unstable and integrating systems under step response

A simple but effective on-line method to estimate the delay from step response, which can be used for stable, unstable and integrating systems, is proposed in this paper. The estimation and control are made simultaneously since the nominal delay is updated in closed-loop based on certain calculus on the output signal. Moreover, the approach is based on a Modified Smith Predictor and the delay estimation is implemented using a multi-model scheme with fixed models. Additionally, the convergence properties of the estimation algorithm and the stability analysis of the closed-loop are well-defined. Simulation examples show the effectiveness of the proposed method, where the delay estimation leads to an optimal and robust controller, tackling the uncertainty in the delay.

High speed silicon electro-optical modulators enhanced via slow light propagation

While current optical communication networks efficiently carry and process huge amounts of digital information over large and medium distances, silicon photonics technology has the capacity to meet the ceaselessly increasing demand for bandwidth via energy efficient, inexpensive and mass producible short range optical interconnects. In this context, handling electrical-to-optical data conversion through compact and high speed electro-optical modulators is of paramount importance. To tackle these challenges, we combine the attractive properties of slow light propagation in a nanostructured periodic waveguide together with a high speed semiconductor pn diode, and demonstrate a highly efficient and mass manufacturable 500 µm-long silicon electro-optical device, exhibiting error free modulation up to 20 Gbit/s. These results, supported by modulation rate capabilities reaching 40 Gbit/s, pave a foreseeable way towards dense, low power and ultra fast integrated networks-on-chip for future chip-scale high performance computing systems.

Variant of the anastigmatic telescope with three mirrors for back focal length

In this paper, an optical design is presented for an anastigmatic telescope with back focal length corrected with exact ray tracing to eliminate spherical, coma, and astigmatism aberrations. The telescope is formed of three conical mirrors, two of them polished on the same substratum. The optical design is divided into three stages: we began the design obtaining the Gaussian parameters in a first-order solution; posteriorly, were obtained analytically the three mirrors' asphericity in a third-order design. The final design stage consists of the implementation of the Fermat's principle, the Abbe sine condition, and the Coddington equations for the exact correction for the three aforementioned aberrations.

Symmetrical ambulatory arterial stiffness index: relationship with microalbuminuria and renal function

OBJECTIVE

The aim of this study was to investigate the arterial stiffness parameters derived from the proposed linear relationship between SBP and DBP obtained by ABPM, regarding its relationships with two markers of renal disease, microalbuminuria and renal function.

DESIGN AND METHODS

One hundred and sixty six patients were studied: 73 males and 93 females mean age 55.2+/-15.5 years. 36.2% were receiving antihypertensive drug treatment. Microalbuminuria was measured in 24-h urine collection as well as albumin to creatinine ratio (ACR) in first morning urine. The ambulatory BP was measured non-invasively for 24 h by the Spacelab devices.

RESULTS

Correlation test showed a significant relationship of Sym-AASI with age (p<0.001), serum creatinine (p=0.038), creatinine clearance (-0.423, p<0.001) and GFR (-0.263, p<0.001). On the other hand AASI was also correlated with age (p<0.001) and creatinine clearance (p=0.012), but not with the other parameters studied. 24-h albumin excretion rate was not correlated with Sym-AASI or AASI. Contrariwise, the albumin to creatinine ratio was correlated with Sym-AASI (p=0.013). As expected, AASI and Sym-AASI increase as severity of renal diseases grows. The patients in the highest quartile of Sym-AASI distribution showed an older age (p<0.001) and worse parameters of renal function (GFR, p<0.001; and creatinine clearance, p<0.008).

CONCLUSIONS

Sym-AASI, an improved method for detecting arterial stiffness, seems to get an independent relationship with these parameters of renal disease which could not be detected with AASI.

Frequency of Fabry disease in male and female haemodialysis patients in Spain

BACKGROUND

Fabry disease (FD), an X-linked lysosomal storage disorder, is caused by a reduced activity of the lysosomal enzyme alpha-galactosidase A. The disorder ultimately leads to organ damage (including renal failure) in males and females. However, heterozygous females usually present a milder phenotype with a later onset and a slower progression.

METHODS

A combined enzymatic and genetic strategy was used, measuring the activity of alpha-galactosidase A and genotyping the alpha-galactosidase A gene (GLA) in dried blood samples (DBS) of 911 patients undergoing haemodialysis in centers across Spain.

RESULTS

GLA alterations were found in seven unrelated patients (4 males and 3 females). Two novel mutations (p.Gly346AlafsX347 and p.Val199GlyfsX203) were identified as well as a previously described mutation, R118C. The R118C mutation was present in 60% of unrelated patients with GLA causal mutations. The D313Y alteration, considered by some authors as a pseudo-deficiency allele, was also found in two out of seven patients.

CONCLUSIONS

Excluding the controversial D313Y alteration, FD presents a frequency of one in 182 individuals (0.55%) within this population of males and females undergoing haemodialysis. Moreover, our findings suggest that a number of patients with unexplained and atypical symptoms of renal disease may have FD. Screening programmes for FD in populations of individuals presenting severe kidney dysfunction, cardiac alterations or cerebrovascular disease may lead to the diagnosis of FD in those patients, the study of their families and eventually the implementation of a specific therapy.