Reflections about Blockchain in Health Data Sharing: Navigating a Disruptive Technology

A comprehensive analysis was performed, considering blockchain technology (BT) properties in digital health, addressing medicolegal, privacy, and regulatory considerations. Adherence to personal data protection and healthcare regulatory guidelines were analyzed and compared for GDPR (Europe), HIPAA (United States), CCPA (California), PIPEDA (Canada), the Privacy Act of 1988 (Australia), APPI (Japan), and LGPD (Brazil). Issues such as health systems, strengthening and aligning policy orientations and initiatives, and emphasizing the role of data analysis in shaping health policies were explored. The study addressed conflicts between the legal frameworks and blockchain, comparing and suggesting solutions like the revision of laws and the integration of compliance mechanisms. Additionally, it sought to enhance IT-health literacy by integrating the healthcare and legal domains. Ongoing collaboration between legal, health, and IT experts is essential for designing systems that effectively balance privacy rights and data protection while maximizing the benefits of disruptive technologies like blockchain.

Oral health professional intervention and child physical abuse-European legal approach

Physical violence against children and adolescents is an issue of Global Public Health. This study aims to identify traumatic injuries and the medicolegal temporary framework of the victim's profile in the European legal approach. Participants and setting include the following: the clinical reports of a Portuguese European Clinical Academic Center database were analysed. An observational and prospective cohort study was performed. A descriptive analysis of the variables was conducted, considering gender, bimodal age groups, place of residence, offender data, place of occurrence, aetiology, localization, type of injuries, personal injury assessment by Quantum doloris, and injury time. The statistical analysis was performed by Spearman's rho and Kendall's tau-b correlation tests, Pearson's chi-square test of independence (χ2), and Mann-Whitney and Kruskal-Wallis nonparametric tests (P < 0.05). The relationship between age groups and the place of occurrence was statistically significant (P = 0.001). Orofacial and nonorofacial injuries were related (P = 0.035). The General Data Protection Regulation is not a barrier to the treatment and sharing of justified data but a framework for safeguarding individuals' fundamental rights, including the Right to Health. Meticulous reporting of the clinical situation involves the victim, the occurrence, and the potential offender.

Key points

An oral health professional's notification of the event is a fundamental step of the judicial process.The timeline is the core of traumatic injury assessment in a child physical abuse scenario.Medicolegal evaluation impacts disability prevention, imputability, and notification of the crime.

Temporomandibular trauma and reflections on personal evaluation

The International Consortium Network/Orofacial Pain Special Interest Group focuses on temporomandibular disease diagnosis procedure guidelines as a reference iQAn this scope. Concerning this reference, the aim of this study was to comprehensively analyze injury and sequela frames within European and American approaches to personal damage. A quasiexperimental pilot study of Portuguese orofacial trauma cases in a medico-legal evaluation database was performed with an interrupted time series design. The clinical data were recorded following five criteria of TMJ diagnosis (jaw opening, pain, anatomical deficit, functional deficit, clinical sounds, and occlusal deficit) under three degrees of severity. The injury frame evaluation was recorded in the first-degree stage in all criteria. Pain, as a sequela, was the criterion present in 45% of the sample as spontaneous (20%) or stimulated (25%). Temporomandibular trauma damage evaluation emphasizes the accurate injury diagnosis and sequela framework. Orofacial trauma analysis should focus on the inclusion or exclusion of a TMD diagnosis. This study suggests revising the reference tables on personal damage, considering the inclusion of TMD and its categorization and impact.

Cystoisospora suis in Portugal: an observational study of prevalence, management, and risk factors

BACKGROUND

Neonatal coccidiosis is a common and important disease of suckling piglets in modern farming caused by Cystoisospora suis. Prevalence rates are high, namely, in Portugal, although no recent data are available. The metaphylactic administration of a single dose of toltrazuril and hygienic measures are the backbone of control strategies on positive farms. However, several studies have shown that these programs are not always effective, underlining the need to revise the risk factors and control strategies currently applied. The present study evaluated C. suis prevalence on Portuguese farms and assessed the risk factors associated with facilities and farm rearing practices.

RESULTS

From the 27 tested farms, 23 were positive to Cystoisopora suis (85.2%). In total, 258 litters were sampled (accounting for 516 samples-2 samples per litter), with an average of 59.7% of positive litters per positive farm. Faecal pools from litters, in which liquid faeces predominated had a higher probability of containing oocysts than litter pools with mainly solid (Odds Ratio: 9.87; p < 0.0001) or pasty faeces (OR: 7.05; p = 0.001), and samples obtained from younger animals had higher oocyst counts (coefficient: - 0.0720; 95% CI - 0.125; - 0.019). No significant effect of toltrazuril administration was observed on the positivity rate, and none of the tested farms used disinfectants with official claims against parasites and known anticoccidial effects (e.g., cresol-based products).

CONCLUSIONS

The C. suis prevalence on Portuguese swine farms appears to be similar to the prevalence found in other European countries. Repeated sampling of the same litter and the use of autofluorescence microscopy after a modified Ritchie technique seems to have increased sensitivity and consequently the detection rate of positive litters. Finally, despite the common use of oral toltrazuril, C. suis control programs appear to not always be effective (based on the detection of oocysts in faecal samples), suggesting the need to revise the control strategies applied in the field, including management factors and choices of disinfectant products.

One-step laparoscopy-guided abomasopexy versus omentopexy via right flank laparotomy to treat left displaced abomasum in dairy cows, in relation to return of milk yield

This study compared two surgical techniques for treating left displaced abomasum (LDA) in dairy cows. The two techniques were compared in terms of milk production at different time intervals: before surgery; on the day of the surgery; and at 8, 15 and 30 days after surgery. The surgical techniques used in this study were laparoscopy-guided abomasopexy and right flank laparotomy omentopexy. A total of 126 lactating Holstein-Friesian cows with LDA were included, 63 of which were treated with laparoscopy, and 63 with right flank laparotomy. Cows with retained foetal membranes, metritis or natural delivery (dystocia) were included and registered on field sheets for subsequent statistical analysis. Cows with clinical mastitis were excluded. A blood sample (5 mL) was obtained from the medial coccygeal vein and analyzed for total proteins, total bilirubin, total calcium, glucose, b-hydroxybutyrate, sodium, potassium, and chloride. No differences were found between the two groups of operated cows with respect to the number of lactation days, body condition score (BCS), rectal temperature, heart rate, and respiratory rate before surgery. No differences were observed between groups regarding the biochemical parameters (P > 0.05) analyzed, except for chloride, which presented lower average values in the omentopexy group (P <0.05). Return of milk yield within the study period did not differ significantly between the laparoscopy and laparotomy groups (P > 0.05), although a significant change in post-surgery time was observed. .

Characterization and Validation of Flexible Dry Electrodes for Wearable Integration

When long-term biosignal monitoring is required via surface electrodes, the use of conventional silver/silver chloride (Ag/AgCl) gelled electrodes may not be the best solution, as the gel in the electrodes tends to dry out over time. In this work, the electrical behaviour and performance of dry electrodes for biopotential monitoring was assessed. Three materials were investigated and compared against the gold-standard Ag/AgCl gelled electrodes. To characterize their electrical behaviour, the impedance response over the frequency was evaluated, as well as its signal to noise ratio. The electrodes' performance was evaluated by integrating them in a proven electrocardiogram (ECG) acquisition setup where an ECG signal was acquired simultaneously with a set of dry electrodes and a set of standard Ag/AgCl gelled electrodes as reference. The obtained results were morphologically compared using the Normalised Root Mean Squared Error (nRMSE) and the Cosine Similarity (CS). The findings of this work suggest that the use of dry electrodes for biopotential monitoring is a suitable replacement for the conventional Ag/AgCl gelled electrodes. The signal obtained with dry electrodes is comparable to the one obtained with the gold standard, with the advantage that these do not require the use of gel and can be easily integrated into fabric to facilitate their use in long-term monitoring scenarios.

The COVID-19 Impact on Oral Healthcare Demand and Performance: The Experience of a Clinical and Academic Centre in Portugal (EU)

INTRODUCTION

The SARS-CoV-2 pandemic has reshaped the global landscape as we know it and had a tremendous effect on healthcare systems around the world. However, its impact on oral healthcare is still to be fully assessed. The aim of this study was to understand if and how COVID-19 affected the demand and performance of oral healthcare, taking the Clinical and Academic Centre of Coimbra as an example, more specifically, the Department of Stomatology of the Coimbra Hospital and University Centre and the Dentistry Department of the Faculty of Medicine of the University of Coimbra.

MATERIAL AND METHODS

An observational study was designed for collecting the data of a series of key oral healthcare indicators: number of appointments; referrals from primary healthcare; missed appointments; number of surgeries performed in the operating room; number of biopsies; number of patients admitted through the emergency department and epidemiologic parameters over two 18-month periods between September 2018 and August 2021: pre-COVID-19 and during the COVID-19 pandemic, with the latter divided in four stages. A statistical analysis which included descriptive and inferential procedures was then performed, with an established significance level of 5% and the application of parametric tests, t-Student test for a sample and for independent samples and One-Way ANOVA for the variance analysis.

RESULTS

There was a general decline in all indicators comparing the pre-COVID-19 with the COVID-19 period, with a reduction of 50.61% in the number of appointments, 44.06% in referrals, 24.41% in surgeries, 26.30% in biopsies and 32.33% in patients seen in the Emergency Room. The number of missed appointments also increased by 181.82%. All variations revealed statistically significant differences (p < 0.05). The individual COVID-19 stage analysis, when compared with the pre-COVID-19 reference, and variance analysis of these different stages also showed statistically significant differences (p < 0.05 and p < 0.001), except for the number of biopsies during the third and fourth stages.

CONCLUSION

The results of this study suggest that the SARS-CoV-2 pandemic has had a considerable impact on oral healthcare demand and performance. However, results also show a remarkable adjustment and improvement in the provided care, with a positive evolution throughout the COVID-19 period.

Blockchain technology in migrant and refugee health: A scoping review

Background

The increase of forcibly displaced people worldwide is a challenge for health systems and their ability to provide access and equity in Health as a universal right. In the case of migrants and refugees, their journey exacerbates this challenge, as they go through diverse countries, camps, and humanitarian teams. Hence, the collection and analysis of health data are essential in providing quality care. The scientific community has been studying health digital technologies to answer health data consolidation, transparency, and global surveillance efficiency issues. Observing some empirical experiments with Blockchain in migrants and refugee health, we assessed the state-of-the-art by conducting a literature review.

Methods

Blockchain applications are still emerging, which means that peer-reviewed literature may still be scarce in life science databases. Therefore, to gather the most appropriate available evidence, we used a diverse and balanced set of databases that compile articles and journals from different fields. We used a multi-step scoping review to refine search keywords and analyse the literature. We included studies between 2008 and 2021 that reported value, utility, or use cases of Blockchain in support of migrant and refugee health.

Results

We identified a total of 69 articles, with 22 retained for full-text analysis and 8 of those being relevant. We employed Rayyan application to manage and evaluate the references by two researchers working independently. We identified two main uses of Blockchain technology to support migrant and refugee health: mitigate the lack of personal identification and make health records available. Blockchain also promotes data reliability in humanitarian aid, academic certificates, legal contracts, and financial transactions.

Conclusions

The availability of reliable information about individuals facilitates universal health coverage, improves cooperation between diaspora-related countries, and supports global health efficiency in line with the third goal of the Sustainable Development Goals 2030 agenda. Given its characteristics of decentralization, resilience, transparency, and auditability, Blockchain remains a promising avenue for future research in migrant and refugee health.

Rapid Detection of Actinobacillus pleuropneumoniae From Clinical Samples Using Recombinase Polymerase Amplification

Actinobacillus pleuropneumoniae (APP) is the causative agent of porcine pleuropneumonia, resulting in high economic impact worldwide. There are currently 19 known serovars of APP, with different ones being predominant in specific geographic regions. Outbreaks of pleuropneumonia, characterized by sudden respiratory difficulties and high mortality, can occur when infected pigs are brought into naïve herds, or by those carrying different serovars. Good biosecurity measures include regular diagnostic testing for surveillance purposes. Current gold standard diagnostic techniques lack sensitivity (bacterial culture), require expensive thermocycling machinery (PCR) and are time consuming (culture and PCR). Here we describe the development of an isothermal point-of-care diagnostic test - utilizing recombinase polymerase amplification (RPA) for the detection of APP, targeting the species-specific apxIVA gene. Our APP-RPA diagnostic test achieved a sensitivity of 10 copies/μL using a strain of APP serovar 8, which is the most prevalent serovar in the UK. Additionally, our APP-RPA assay achieved a clinical sensitivity and specificity of 84.3 and 100%, respectively, across 61 extracted clinical samples obtained from farms located in England and Portugal. Using a small subset (n = 14) of the lung tissue samples, we achieved a clinical sensitivity and specificity of 76.9 and 100%, respectively) using lung imprints made on FTA cards tested directly in the APP-RPA reaction. Our results demonstrate that our APP-RPA assay enables a suitable rapid and sensitive screening tool for this important veterinary pathogen.

Sex and age biological variation of the mandible in a Portuguese population- a forensic and medico-legal approaches with three-dimensional analysis

The medico-legal identification is based on a set of discriminatory characteristics between individuals in their biological, social, cultural, religious, legal and economic framework. The purpose of this study was to characterize the biological variation, regarding gender and age, in a Portuguese population. A three-dimensional (3D) analysis of 215 mandibles (7-20 years old) from the database of the Laboratory of Forensic Dentistry, Faculty of Medicine, University of Coimbra (CE-112/2019) was performed. A total of 13 cephalometric points defined 10 linear variables and 7 angular variables, on 3D reconstructions from ConeBeam Computed Tomography (CBCT) images. Intra and inter-observer errors were analyzed by Technical Measurement Error test. A descriptive statistics was performed. To verify the influence of gender and age on the variables and to determine its predictive value, ANOVA and Logistic Regression Analysis were performed. Gender and age influence most of the linear variables, however, the same is not true for angular variables. In the analysis of all variables, the model has a reasonable level of sensitivity (67.8%) according to gender. For the age prediction, with all variables, the model presented a reasonable level of sensitivity, classifying 79.4% of the individuals. The results supported, with a high level of statistical significance, an adequate recognition of individuals highlighting the identification and criminal imputability of Portuguese individuals.

Cone Beam Computed Tomography (CBCT) Technology and Learning Outcomes in Dental Anatomy Education: E-Learning Approach

E-learning is an educational method that improves knowledge innovation by sharing relevant images for advanced learning, especially in a pandemic state. Furthermore, cone-beam computed tomography (CBCT) is a method that gathers medical or dental diagnostic images. This study aimed to analyze the effectiveness of dental anatomy education through a CBCT technology tool, through teachers' and students' perspectives, adjusted according to the disruptions caused by the Covid-19 pandemic. A cohort study and longitudinal exploratory analysis were performed. Forty undergraduate first-year dental students, from the University of Coimbra in Portugal, were selected as per the inclusion and exclusion criteria. Two different teaching methods were applied during an identical time-period: face-to-face lectures complemented by physical models (T1 cohort) and webinar lectures complemented by CBCT images (T2 cohort). Learning outcomes were then studied according to theoretical and spatial orientation contexts. A self-reported survey that focused on students' satisfaction, stress, and support was studied. Both teaching methods were analyzed with paired sample student's t-test and Pearson Correlation Confidence intervals 95% with P < 0.05. Furthermore, exploratory factor analysis (EFA) was used for self-reported satisfaction survey validity and reliability analysis. The learning outcomes between T1 and T2 cohorts were statistically significant, (P < 0.001) corresponding to differences with a large effect degree (r > 0.60). Students' satisfaction, as measured on a six-point Likert scale, was positively influenced by the webinar lectures supplemented with CBCT images (T2 cohort) in a learning context (4.95 ± 0.5) and future applications (5.92 ± 0.27). In conclusion, the webinar approach with CBCT images was more effective and better learning method for teaching dental anatomy.

Orofacial trauma injuries and disability assessment in adolescents: A Portuguese study

BACKGROUND/AIMS

Orofacial injuries are a significant public health issue. The evidence-based knowledge associated with adolescent violence and trauma is highlighted by the World Health Organization with regard to its specific needs related to disability, violence, and unintentional injuries. The main aim of this study was to present evidence-based information about orofacial traumatic injuries of an adolescent population using Portuguese epidemiological data. The second aim was to report follow-up data of injuries for disability assessment in a trauma prevention approach.

METHODS

An observational cohort study was performed using the clinical database of the national-specialist-healthcare-centre-of-trauma (2014-2018). Information was collected regarding gender, school age range, etiology, injury type, injury time, and severity. Mann-Whitney (p < .05), Kruskal-Wallis (p < .001), and Cox regression (p < .001) analyses were performed.

RESULTS

Orofacial trauma injuries were present in 23.3% of Portuguese adolescents (age range 10-18 years). The majority were male (72.6%), and no age range stood out in frequency. School accidents (90.6%) were the major etiology for all groups of injuries. The diagnosis of superficial intraoral injuries was the most frequent (50.8%), followed by similar injuries to the face (22.5%). A Cox regression model with an adequate fit was yielded (χ2 [6] = 54.893, p < .001), suggesting that variable injury type was a predictor of disability, considering injury time. Tooth and alveolar loss, complicated tooth fracture, complicated face injury, and temporomandibular injuries were more predictive (1<hazard ratio < 5.329 [95% CI:1.340-12.685]).

CONCLUSION

The type of injury could be used to predict the time of temporary disability. Regarding definitive damage, some injuries were more predictive of severity than others. Preventive procedures should be highlighted in schools.

Study of the K_{L}→π^{0}νν[over ¯] Decay at the J-PARC KOTO Experiment

The rare decay K_{L}→π^{0}νν[over ¯] was studied with the dataset taken at the J-PARC KOTO experiment in 2016, 2017, and 2018. With a single event sensitivity of (7.20±0.05_{stat}±0.66_{syst})×10^{-10}, three candidate events were observed in the signal region. After unveiling them, contaminations from K^{±} and scattered K_{L} decays were studied, and the total number of background events was estimated to be 1.22±0.26. We conclude that the number of observed events is statistically consistent with the background expectation. For this dataset, we set an upper limit of 4.9×10^{-9} on the branching fraction of K_{L}→π^{0}νν[over ¯] at the 90% confidence level.

UC-USP collaborative exercise on photobiomodulation therapy in neurological orofacial disturbances

Background

Neurosensory peripheral disorders are one of the most common risks associated with iatrogenic and/or post-traumatic injuries. It is often related to disability. Photobiomodulation therapy (PBMT) is a nonsurgical and safe procedure which can accelerate and improve the regeneration of injured biological tissue. This study aims to analyze the impact of PBMT, in the quality of life and impairment of individuals with orofacial neurological peripheral disturbance.

Material and Methods

A retrospective analysis in the database of the dental traumatology clinic of the Hospital Centre of the University of Coimbra/Faculty of Medicine of the University of Coimbra was performed.5 out of 50 individuals were selected, according to the selection criteria. The neurosensory activity was assessed by a pinprick nociceptive test and the EQ-5D-5L self-report questionnaire was used to analyse the quality of life. The study was performed in two phases:1) inactive laser or placebo phase, for one month and 2) active laser or treatment phase. A diode low-level laser device (SIROLaserBlue;Sirona,Germany) was used, according to our protocol. A collaborative protocol in the PBMT influence in individuals with neurosensory peripheral disturbances was studied.

Results

There was no improvement in the neurosensory activity nor in the quality of life, in the placebo phase. After the treatment phase, the EQ-5D-5L final results reported no problems in all of the five dimensions, except for anxiety/depression in individuals with long-standing neurosensory peripheral disturbances. The EQ-VAS scores increased in all the individuals.

Conclusions

Our results supported the improvement of quality of life and impairment reduction in the individuals submitted to PBMT.

Key words:Low-level light therapy, peripheral nerve injuries, sensation disorders, quality of life, forensic medicine.

Chemical composition of rainwater under two events of aerosol transport: A Saharan dust outbreak and wildfires

A one-year campaign of joint sampling of aerosols and precipitation, carried out in León, Spain, allowed to study the impact of two special events that affected the air quality in the north of the country, on rainfall in the city: a period with wildfires and a Saharan dust intrusion. The wildfires that occurred in northern Portugal and northwestern Spain in August 2016 affected the chemistry of rainfall on 15 August 2016, causing an increase in concentrations of NH₄⁺, Na⁺, Cl^-, K⁺, Mg²⁺, Ca²⁺, SO₄^2- and NO₃^- and in the concentrations of organic acids, which was reflected in the levels of soluble and insoluble organic carbon. This led to acidification of rainwater (pH = 4.8). The second precipitation event was registered between 11 and 14 February 2017, during which the rainwater was collected in four daily fractions (P₁, P₂, P₃ and P₄). The rain sample of 12 February (P₂) coincided with a Saharan dust intrusion that reached northern Iberia that day. The chemical composition of P₂ showed an increase in the Ca²⁺ (>800%), Mg²⁺ (71%), Cl^- (62%), and SO₄^2- (33%) concentrations, with respect to P₁. The input of crustal elements to the atmosphere helped to neutralize the P₂ rainwater, causing pH values higher than 6.5. Once the dust intrusion left the north of the Peninsula, the composition of rainwater P₃ and P₄ revealed a mixture of marine contribution with local anthropogenic emissions, as well as a decrease in ion concentrations and conductivity, and an increase in pH values.

Risk factors associated with inflammatory bowel disease: A multicenter case-control study in Brazil

BACKGROUND

The etiology of inflammatory bowel disease (IBD) is unknown, but it is believed to be multifactorial. The hygiene hypothesis proposes that better hygiene conditions would lead to less infectious disease during childhood and favor the development of immune-mediated diseases.

AIM

To test the hygiene hypothesis in IBD by assessing the environmental risk factors associated with IBD development in different regions of Brazil with diverse socioeconomic development indices.

METHODS

A multicenter case-control study was carried out with 548 Crohn’s disease (CD) and 492 ulcerative colitis (UC) outpatients and 416 healthy controls, from six IBD centers within different Brazilian states at diverse socioeconomic development stages. A semi-structured questionnaire with 87 socioeconomic and environmental questions was applied. Logistic regression model was created to assess the odds ratio (OR) with P value and 95% confidence intervals (CI).

RESULTS

Predictive variables for both diseases (CD and UC) were women [odd ratios (OR) = 1.31; OR = 1.69], low monthly family income (OR = 1.78; OR = 1.57), lower number of cohabitants (OR = 1.70; OR = 1.60), absence of vaccination (OR = 3.11; OR = 2.51), previous history of bowel infections (OR = 1.78; OR = 1.49), and family history of IBD (OR = 5.26; OR = 3.33). Associated risk factors for CD were age (18-39 years) (OR = 1.73), higher educational level (OR = 2.22), absence of infectious childhood diseases (OR = 1.99). The UC predictive variables were living in an urban area (OR = 1.62), inadequate living conditions (OR = 1.48) and former smokers (OR = 3.36). Appendectomy was a risk factor for CD (OR = 1.58) with inverse association with UC (OR = 4.79). Consumption of treated and untreated water was associated with risk of CD (OR = 1.38) and UC (OR = 1.53), respectively.

CONCLUSION

This is the first examining environmental exposures as risk factors for inflammatory bowel disease in Brazil. Most of the variables associated with disease risk support the role of the hygiene hypothesis in IBD development.

Canine parvovirus: a predicting canine model for sepsis

BACKGROUND

Sepsis is a severe condition associated with high prevalence and mortality rates. Parvovirus enteritis is a predisposing factor for sepsis, as it promotes intestinal bacterial translocation and severe immunosuppression. This makes dogs infected by parvovirus a suitable study population as far as sepsis is concerned. The main objective of the present study was to evaluate the differences between two sets of SIRS (Systemic Inflammatory Response Syndrome) criteria in outcome prediction: SIRS 1991 and SIRS 2001. The possibility of stratifying and classifying septic dogs was assessed using a proposed animal adapted PIRO (Predisposition, Infection, Response and Organ dysfunction) scoring system.

RESULTS

The 72 dogs enrolled in this study were scored for each of the PIRO elements, except for Infection, as all were considered to have the same infection score, and subjected to two sets of SIRS criteria, in order to measure their correlation with the outcome. Concerning SIRS criteria, it was found that the proposed alterations on SIRS 2001 (capillary refill time or mucous membrane colour alteration) were significantly associated with the outcome (OR = 4.09, p < 0.05), contrasting with the 1991 SIRS criteria (p = 0.352) that did not correlate with the outcome. No significant statistical association was found between Predisposition (p = 1), Response (p = 0.1135), Organ dysfunction (p = 0.1135), total PIRO score (p = 0.093) and outcome. To explore the possibility of using the SIRS criteria as a fast decision-making tool, a Fast-and-Frugal tree (FFT) was created with a sensitivity of 92% and a specificity of 29%.

CONCLUSION

These results suggest that increasing the SIRS criteria specificity may improve their prognostic value and their clinical usefulness. In order to improve the proposed PIRO scoring system outcome prediction ability, more specific criteria should be added, mainly inflammatory and organ dysfunction biomarkers.

Rhizobium response to sole and combined exposure to cadmium and the phytocompounds alpha-pinene and quercetin

Soils can be contaminated with substances arising from anthropogenic sources, but also with natural bioactive compounds produced by plants, such as terpenes and flavonoids. While terpenes and flavonoids have received much less attention from research studies than metals, the effects that phytocompounds can have on soil organisms such as beneficial microorganisms should not be neglected. Herein we report the sole and combined exposure of Rhizobium to cadmium, to the monoterpene alpha-pinene and to the flavanol quercetin. A range of environmentally relevant concentrations of the phytocompounds was tested. Physiological (growth, protein content and intracellular Cd concentration), oxidative damage (lipid peroxidation, protein carbonylation) and antioxidant mechanisms (superoxide dismutase, catalase, glutathione, glutathione-S-transferases, protein electrophoretic profiles) were assessed. Results suggest that exposure to both phytocompounds do not influence Rhizobium growth, but for combined exposure to phytocompounds and Cd, different responses are observed. At low concentrations, phytocompounds seem to relieve the stress imposed by Cd by increasing antioxidant responses, but at high concentrations this advantage is lost and membrane damage may even be exacerbated. Thus, the presence of bioactive phytocompounds in soil may influence the tolerance of microorganisms to persistent toxicants, and may change their impact on the environment.

Aethalometer measurements in a road tunnel: A step forward in the characterization of black carbon emissions from traffic

A sampling campaign was conducted in the Liberdade Avenue tunnel (Braga, Portugal) during a week (with 56,000 vehicles) to monitor black carbon (eBC-equivalent black carbon) by means of an Aethalometer AE-31, and gaseous pollutants (CO₂, CO, NO_x). Inside the tunnel, the mean eBC mass concentration was 21 ± 10 μg m^-3, reaching a maximum hourly value of 49.0 μg m^-3. An hourly and weekday-weekend study was carried out. Regarding the Absorption Ångström exponent (AAE), a mean value of 0.97 ± 0.10 was obtained, for a source of practically pure traffic. There was a positive significant correlation between eBC and the number of light vehicles (r = 0.47; p < 0.001) and between eBC and the gaseous emissions: CO (r = 0.67; p < 0.001), CO₂ (r = 0.71; p < 0.001), NO (r = 0.63; p < 0.001) and NO₂ (r = 0.70; p < 0.001). The mean black carbon emission factors (EF_BC) inside the tunnel were 0.31 ± 0.08 g (kg fuel)^-1 and 0.11 ± 0.08 mg veh^-1 km^-1, similar to those found in other studies for gasoline and diesel vehicles in road tunnels.

Unusual winter Saharan dust intrusions at Northwest Spain: Air quality, radiative and health impacts

Saharan air masses can transport high amounts of mineral dust particles and biological material to the Iberian Peninsula. During winter, this kind of events is not very frequent and usually does not reach the northwest of the Peninsula. However, between 21 and 22 February 2016 and between 22 and 23 February 2017, two exceptional events were registered in León (Spain), which severely affected air quality. An integrative approach including: i) typical synoptic conditions; ii) aerosol chemical composition; iii) particle size distributions; iv) pollen concentration; v) aerosol optical depth (AOD); vi) radiative forcing and vii) estimation of the impact of aerosols in the respiratory tract, was carried out. In the global characterization of these events, the exceedance of the PM₁₀ daily limit value, an increase in the coarse mode and a rise in the iron concentration were observed. On the 2016 event, an AOD and extinction-related Ångström exponent clearly characteristic of desert aerosol (1.1 and 0.05, respectively) were registered. Furthermore, pollen grains not typical of flowering plants in this period were identified. The chemical analysis of the aerosol from the 2017 event allowed us to confirm the presence of the main elements associated with mineral sources (aluminum, calcium, and silica concentrations). An increase in the SO₄^2-, NO₃^- and Cl^- concentrations during the Saharan dust intrusion was also noted. However, in this event, there was no presence of atypical pollen types. The estimated dust radiative forcing traduced a cooling effect for surface and atmosphere during both events, corroborated by trends of radiative flux measurements. The estimated impact on the respiratory tract regions of the high levels of particulate matter during both Saharan dust intrusions showed high levels for the respirable fraction.

Protective effects of farnesol on a Rhizobium strain exposed to cadmium

Soil acts as a repository for many metals that human activity releases into the environment. Cadmium enters agricultural soils primarily from application of phosphate fertilizers and sewage sludge. Among soil bacteria, rhizobia have a great agronomic and environmental significance and are major contributors to a sustainable maintenance of soil fertility. However, the services that this group of microorganisms provides are affected by environmental constraints, such as Cd contamination. Bioactive compounds also influence soil microorganisms. Farnesol is a phytocompound with recognized bioactivity, inducing both beneficial and harmful effects. In this study, Rhizobium sp. strain E20-8 was exposed to sole or combined exposure to Cd and farnesol. Results showed that farnesol (25 and 200 µM) did not affect rhizobia; exposure to Cd (µM) inhibited rhizobia growth and induced several biomarkers of oxidative stress; exposure to the combination of farnesol and Cd reduced oxidative damage, and the highest concentration of farnesol tested reduced Cd accumulation and allowed a significant growth recovery. Farnesol protective effects on rhizobia exposed to Cd is novel information which can be used in the development of microbe-based environmental engineering strategies for restoration of metal contaminated areas.

Bacteria causing pyometra in bitch and queen induce neutrophil extracellular traps

Neutrophils are capable of releasing their DNA in response to infectious agents to form neutrophil extracellular traps (NETs) to destroy pathogens. Even though pyometra in queens and bitches is a common disease, its pathogenesis is not fully understood. The aim of this study was to assess the presence of NETs in the endometrium of queens and bitches suffering from pyometra. Pyometra and normal uteri were obtained after ovariohysterectomy from adult queens and bitches in diestrus. Uterine contents were evaluated for bacterial isolation and identification and for NETs presence. Escherichia coli were isolated in 5/5 queens and 4/5 bitches, and Streptococcus spp in one bitch. Sterile glass coverslips were placed on the endometrium surface to obtain material for NETs that were evaluated by immunocytochemistry (histone, neutrophil elastase or myeloperoxidase), fluorescence microscopy or scanning electron microscopy. NETs in endometrium content were positively stained by DNA histone DAPI, myeloperoxidase and by neutrophil elastase. NETs were spread in all observed queen and bitch endometria of pyometra cases. Ultrastructure images of NETs depicted clusters of globular material with fine filaments deposited on or around thick filaments and trapped bacteria. To the best of our knowledge these are the first findings confirming NETs endometrial presence in queen and bitch pyometra. Nevertheless, the precise role of NETs in pyometra in the bitch and queen, either to contribute to the defeat of infection or to its persistence remains to be unraveled.

Crohn’s disease environmental factors in the developing world: A case-control study in a statewide catchment area in Brazil

AIM

To identify environmental risk factors associated with the development of Crohn’s disease (CD) in order to re-assess the hygiene hypothesis.

METHODS

A hospital-based, case-control study was carried out with CD patients (n = 145) and controls (n = 163) representing a socioeconomically diverse statewide catchment area in Brazil. Controls were recruited from caregivers of patients seen in different outpatient clinics at the same hospital. A multi-item survey with 94 questions regarding family history of CD, perinatal and childhood circumstances, living conditions, tobacco use and familial socioeconomic status was carried out by interviewers.

RESULTS

On the univariate analysis, predictive variables for CD included being male, under age of 40, a high education level, urban dweller, smaller family size, exposure to enteric pathogens and user of treated water (P < 0.005). On the multivariate analysis, variables significantly associated with CD were male gender (OR = 2.09), under age 40 (OR = 3.10), white (OR = 2.32), from a small family in childhood (OR = 2.34) and adulthood (OR = 3.02), absence of viral infections in childhood (OR = 2.23), exposure to enteric pathogens (OR = 2.41), having had an appendectomy (OR = 2.47) and prior or current smoker (OR = 2.83/1.12).

CONCLUSION

Most variables supporting the “hygiene hypothesis” are associated with the development of CD but are not independent predictors of the diagnosis.

Role of the Microbiota in Colorectal Cancer: Updates on Microbial Associations and Therapeutic Implications

Genetic, environmental, and dietary factors have been found to influence the development and progression of colorectal cancer (CRC). More recently, accumulating evidence associates the intestinal microbiota with the initiation and progression of this disease. While studies have shown that individuals with CRC display alterations in gut bacterial composition, it remains somewhat unclear whether such differences drive cancer development or whether they are a response to tumorigenesis. In this review, the authors assess new evidence linking the community structure or specific bacterial factors of the intestinal microbiota to CRC development and progression, with insights into therapeutic implications.

Emissions from the combustion of eucalypt and pine chips in a fluidized bed reactor

Interest in renewable energy sources has increased in recent years due to environmental concerns about global warming and air pollution, reduced costs and improved efficiency of technologies. Under the European Union (EU) energy directive, biomass is a suitable renewable source. The aim of this study was to experimentally quantify and characterize the emission of particulate matter (PM2.5) resulting from the combustion of two biomass fuels (chipped residual biomass from pine and eucalypt), in a pilot-scale bubbling fluidized bed (BFB) combustor under distinct operating conditions. The variables evaluated were the stoichiometry and, in the case of eucalypt, the leaching of the fuel. The CO and PM2.5 emission factors were lower when the stoichiometry used in the experiments was higher (0.33±0.1 g CO/kg and 16.8±1.0 mg PM2.5/kg, dry gases). The treatment of the fuel by leaching before its combustion has shown to promote higher PM2.5 emissions (55.2±2.5 mg/kg, as burned). Organic and elemental carbon represented 3.1 to 30 wt.% of the particle mass, while carbonate (CO3(2-)) accounted for between 2.3 and 8.5 wt.%. The particulate mass was mainly composed of inorganic matter (71% to 86% of the PM2.5 mass). Compared to residential stoves, BFB combustion generated very high mass fractions of inorganic elements. Chloride was the water soluble ion in higher concentration in the PM2.5 emitted by the combustion of eucalypt, while calcium was the dominant water soluble ion in the case of pine.

Impact of Smoking Cessation on the Clinical Course of Crohn's Disease Under Current Therapeutic Algorithms: A Multicenter Prospective Study

OBJECTIVES

Given the importance of tobacco smoking (TS) as the only environmental factor repeatedly linked to the development of the Crohn's disease (CD), it is surprising that very few prospective studies have assessed whether TS is associated with an increased frequency of clinical relapse. Our aim was to evaluate the current impact of TS on disease relapse and the clinical benefit of quitting smoking in the present era of widespread use of anti-TNF drugs and immunosuppressants.

METHODS

This was a multicenter prospective cohort study, which included 573 CD patients in clinical remission with various smoking habits. All smokers were advised to quit. Patients not exposed to tobacco before inclusion (non- and former smokers), continuing smokers, and quitters were compared regarding differences in disease outcomes during a follow-up of 4 years.

RESULTS

A total of 148 continuing smokers, 190 nonsmokers, 160 former smokers, and 75 quitters were included. In comparison with nonsmokers, continuing smokers relapsed more frequently with an incidence rate ratio of 1.53 (95% confidence interval (CI): 1.10-2.17). Former smokers and quitters had similar relapse incidences compared with nonsmokers. Smoking was an independent predictor for disease relapse in the multivariate analysis (hazard ratio: 1.58 (95% CI 1.20-2.09). In the time-dependent analysis, continuing smokers had earlier relapse, regardless of anti-TNF or immunosuppressant use.

CONCLUSIONS

Continuing smokers have more disease relapses, and patients who quit smoking have a similar relapse incidence compared with nonsmokers.

SAFETY AND EFFICACY OF ESLICARBAZEPINE ACETATE IN ELDERLY PATIENTS

Purpose

To evaluate the safety/tolerability and efficacy of eslicarbazepine acetate (ESL) as adjunctive therapy in elderly patients with partial-onset seizures (POS).

Method

Phase III, multicentre, open-label, non-controlled study in patients aged ≥65 years with ≥2 POS during an 8-week baseline and treated with 1–2 antiepileptic drugs. Following baseline, patients entered a 26-week maintenance period. ESL was initiated at 400 mg once-daily and adjusted (400–1200 mg/day) based on individual response. Safety/tolerability evaluations included treatment-emergent adverse events (TEAEs), vital signs, 12-lead electrocardiogram and physical/neurological examinations. Efficacy evaluations included change in standardised seizure frequency (SSF; seizure frequency/4 weeks).

Results

Of the 72 patients included, 47 (65.3%) experienced 152 TEAEs; most commonly, dizziness (12.5%), somnolence (9.7%), fatigue (8.3%), convulsion (8.3%) and hyponatraemia (8.3%). Three patients died of cardiac failure, glioblastoma multiforme and ischaemic stroke (relationship unlikely/not related). Overall, 16 (22.2%) patients discontinued due to TEAEs. Incidence of clinically significant findings was low for vital signs, electrocardiogram and physical/neurological examinations. SSF decreased from 2.9 at baseline to 1.2 during the maintenance period (median relative change: –54.1%).

Conclusion

Once-daily ESL (400–1200 mg) as adjunctive therapy in elderly subjects with POS did not raise major safety concerns and was efficacious. Supported by Bial.

High prevalence of vitamin A deficiency in Crohn's disease patients according to serum retinol levels and the relative dose-response test

AIM: To assess the vitamin A status of patients with Crohn’s disease (CD) by evaluating serum retinol levels and the relative dose response (RDR) test (liver retinol stores).

METHODS: Vitamin A nutritional status was measured by serum retinol obtained by high performance liquid chromatography and the RDR test for evaluation of the hepatic stores. Body composition was performed by densitometry by dual-energy X-ray absorptiometry. Vitamin A dietary intake was assessed from a semi-quantitative food frequency questionnaire.

RESULTS: This study included 38 CD patients and 33 controls. Low serum retinol concentrations were detected in 29% of CD patients vs 15% in controls (P < 0.005). The RDR test was positive in 37% of CD patients vs 12% in controls, which indicated inadequate hepatic vitamin A stores (P < 0.005). Individuals with hypovitaminosis A had lower BMI and body fat compared with those without this deficiency. There was no association between vitamin A deficiency and its dietary intake, ileal location, presence of disease activity and prior bowel resections.

CONCLUSION: Patients with CD have higher prevalence of vitamin A deficiency, as assessed by two independent methods.

Influence of chemotherapy for lymphoma in canine parvovirus DNA distribution and specific humoral immunity

In man, the combination of cancer and its treatment increases patients' susceptibility to opportunistic infections, due to immune system impairment. In veterinary medicine little information is available concerning this issue. In order to evaluate if a similar dysfunction is induced in small animals undergoing chemotherapy, we assessed the complete blood count, leukocytic, plasma and fecal canine parvovirus (CPV) viral load, and anti-CPV protective antibody titers, in dogs with lymphoma treated with CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) protocol, before and during chemotherapy. There was no evidence of decreased immune response, either at admission or after two chemotherapy cycles, indicating that the previously established immunity against CPV was not significantly impaired, supporting the idea that immunosuppression as a result of hematopoietic neoplasms and their treatment in dogs requires further investigation and conclusions cannot be extrapolated from human literature.

Focal enhanced gastritis and macrophage microaggregates in the gastric mucosa: potential role in the differential diagnosis between Crohn's disease and ulcerative colitis

CONTEXT AND OBJECTIVES

Focally enhanced gastritis and macrophage microaggregates are found in the upper gastrointestinal involvement of Crohn's disease, and may reflect an underlying defective innate immunity. These features, however, are also described in patients with Helicobacter pylori infection. The role of these gastric abnormalities in the diagnosis of Crohn's disease was assessed in a population with high prevalence of H. pylori infection.

METHODS

Thirty-seven Crohn's disease, 26 ulcerative colitis, and 30 control patients were included. The H. pylori status was evaluated by the rapid urease test and histology. The presence of focally enhanced gastritis and macrophage microaggregates was recorded.

RESULTS

Focally enhanced gastritis was present in 24% of Crohn's disease patients, 4% of ulcerative colitis patients and 11.5% of controls, presenting an overall sensitivity and specificity for Crohn's disease of 24% and 88%, respectively. Macrophage microaggregates were found in all groups, but were only detected in ulcerative colitis and controls in association with H. pylori infection, with an overall sensitivity and specificity for Crohn's disease of 61% and 69%, respectively. In the absence of H. pylori infection, focally enhanced gastritis and macrophage microaggregates were significantly associated with Crohn's disease (P<0.02 and P = 0.001 respectively).

CONCLUSIONS

Focally gastritis and macrophage microaggregates are suggestive of Crohn's disease only in H. pylori-negative specimens.

Neutrophil extracellular traps formation by bacteria causing endometritis in the mare

Besides the classical functions, neutrophils (PMNs) are able to release DNA in response to infectious stimuli, forming neutrophil extracellular traps (NETs) and killing pathogens. The pathogenesis of endometritis in the mare is not completely understood. The aim was to evaluate the in vitro capacity of equine PMNs to secrete NETs by chemical activation, or stimulated with Streptococcus equi subspecies zooepidemicus (Szoo), Escherichia coli (Ecoli) or Staphylococcus capitis (Scap) strains obtained from mares with endometritis. Ex vivo endometrial mucus from mares with bacterial endometritis were evaluated for the presence of NETs. Equine blood PMNs were used either without or with stimulation by phorbol-myristate-acetate (PMA), a strong inducer of NETs, for 1-3h. To evaluate PMN ability to produce NETs when phagocytosis was impaired, the phagocytosis inhibitor cytochalasin (Cyt) was added after PMA. After the addition of bacteria, a subsequent 1-h incubation was carried out in seven groups. NETs were visualized by 4',6-diamidino-2-phenylindole (DAPI) and anti-histone. Ex vivo samples were immunostained for myeloperoxidase and neutrophil elastase. A 3-h incubation period of PMN + PMA increased NETs (p < 0.05). Bacteria + 25 nM PMA and bacteria + PMA + Cyt increased NETs (p<0.05). Szoo induced fewer NETs than Ecoli or Scap (p < 0.05). Ex vivo NETs were present in mares with endometritis. Scanning electron microscopy showed the spread of NETs formed by smooth fibers and globules that can be aggregated in thick bundles. Formation of NETs and the subsequent entanglement of bacteria suggest that equine NETs might be a complementary mechanism in fighting some of the bacteria causing endometritis in the mare.

Lower extremity mobility limitation and impaired muscle function in women with ulcerative colitis

BACKGROUND AND AIM

Fatigue, weakness and musculoskeletal manifestations are associated with IBD. An impaired nutritional status and a reduced physical activity can contribute to these clinical outcomes, impacting quality of life and increasing disability. This study aims to assess muscle strength and lower limb physical performance in female UC patients, taking into consideration disease activity, body composition and habitual physical activity.

METHODS

A case-control study was performed including 23 UC female outpatients and 23 age- and BMI-matched healthy women as controls. Quadriceps strength (QS), handgrip strength (HGS), physical performance based measures (five repetitions sit-up test and 4meter gait speed test), body composition (bioelectrical impedance analysis, anthropometry), and habitual physical activity (HPA) levels were assessed.

RESULTS

UC group had decreased QS (-6%; P=0.012), slower sit-up test (-32%; P=0.000), slower gait speed (-17% P=0.002) and decreased HPA level (-30%, P=0.001) compared with controls. No difference in HGS was observed between groups. Logistic regression showed that UC was an independent factor for decreased QS and slower sit-up test, while HPA was a protective factor for impaired gait speed. Multivariate linear regression showed that BMI was independently associated with an improved QS and slower sit-up test in the UC group.

CONCLUSION

Women with UC had decreased lower limb strength and mobility limitations, which were associated with BMI and the level of physical activity. Early evaluation of nutritional status and performance of the lower limbs could identify UC patients with pre-clinical disability who may benefit from earlier health lifestyle modifications.

Interleukin-33 and inflammatory bowel diseases: lessons from human studies

Interleukin- (IL-) 33 is a widely expressed cytokine present in different cell types, such as epithelial, mesenchymal, and inflammatory cells, supporting a predominant role in innate immunity. IL-33 can function as a proinflammatory cytokine inducing Th2 type of immune response being involved with the defense against parasitic infections of the gastrointestinal tract. In addition, it has been proposed that IL-33 can act as a signaling molecule alerting the immune system of danger or tissue damage. Recently, in the intestinal mucosa, overexpression of IL-33 has been reported in samples from patients with inflammatory bowel diseases (IBD). This review highlights the available data regarding IL-33 in human IBD and discusses emerging roles for IL-33 as a key modulator of intestinal inflammation.

Pancreatitis-associated protein does not predict disease relapse in inflammatory bowel disease patients

Background

The pancreatitis-associated protein (PAP) is increased in the serum of active inflammatory bowel disease (IBD) patients and its levels seem to be correlated with disease activity. Our aim was to evaluate the usefulness of serum and fecal PAP measurements to predict relapse in patients with inactive IBD.

Materials and Methods

We undertook a 12-month prospective study that included 66 Crohn's disease (CD) and 74 ulcerative colitis (UC) patients. At inclusion, patients were in clinical remission, defined by a Harvey-Bradshaw (HB) Index≤4 (CD) or a partial Mayo Score (MS)<3 (UC), along with a normal serum C reactive protein (CRP) and fecal calprotectin. Patients were followed every 3 months. Blood and stool samples were collected and a clinical evaluation was performed at each visit. Serum PAP and CRP levels as well as fecal concentrations of PAP and calprotectin were assessed.

Results

Active CD patients had an increased mean serum PAP at the diagnosis of the flare (104.1 ng/ml) and 3 months prior to activity (22.68 ng/ml) compared with patients in remission (13.26 ng/ml), p<0.05. No significant change in serum PAP levels in UC and fecal PAP levels in CD and UC were detected during disease activity. In CD, serum PAP was a poor diagnostic predictor of disease activity, with an AUC of 0.69. In patients in remission, fecal PAP was barely detectable in UC compared with CD patients.

Conclusion

Serum PAP is increased only in active CD patients, but this marker does not predict disease activity. Inactive UC patients have marked low levels of PAP in fecal samples compared with CD patients.