Evaluation of Expanded Criteria Donors Using the Kidney Donor Profile Index and the Preimplantation Renal Biopsy

The increasing comorbidity of kidney transplant (KT) donors make it necessary to develop scores to correctly assess the quality of kidney grafts. This study analyzes the usefulness of the preimplantation biopsy and the Kidney Donor Profile Index (KDPI) as indicators of KT survival from expanded criteria donors (ECD). Retrospective study of KT in our center between January 2010 to June 2019 who received a kidney from an ECD and underwent a preimplantation biopsy. 266 KT were included. Graft survival was categorized by KDPI quartiles: Q1 = 86%, Q2 = 95%, Q3 = 99% and Q4 = 100%. KT from KDPI Q1 presented better survival (p = 0.003) and Q4 donors had worse renal function (p = 0.018) and poorer glomerular filtration rate (3rd month; p = 0.017, 1st year; p = 0.010). KT survival was analyzed according to KDPI quartile and preimplantation biopsy score simultaneously: Q1 donors with biopsy score ≤3 had the best survival, especially comparing against Q3 with a biopsy score >3 and Q4 donors (p = 0.014). In multivariable analysis, hyaline arteriopathy, glomerulosclerosis, and KDPI Q4 were predictors for graft survival. High KDPI and a greater histological injury in the preimplantation biopsy, especially glomerular and vascular lesions, were related to a higher rate of KT loss from ECD.

Endothelial Nitric Oxide Synthase (eNOS) and the Cardiovascular System: in Physiology and in Disease States

Endothelial nitric oxide synthase (eNOS) plays a critical role in regulating and maintaining a healthy cardiovascular system. The importance of eNOS can be emphasized from the genetic polymorphisms of the eNOS gene, uncoupling of eNOS dimerization, and its numerous signaling regulations. The activity of eNOS on the cardiac myocytes, vasculature, and the central nervous system are discussed. The effects of eNOS on the sympathetic autonomic nervous system (SANS) and the parasympathetic autonomic nervous system (PANS), both of which profoundly influence the cardiovascular system, will be elaborated. The relationship between the eNOS protein with cardiovascular autonomic reflexes such as the baroreflex and the Exercise Pressor Reflex will be discussed. For example, the effects of endogenous nitric oxide (NO) are shown to be mediated by the eNOS protein and that eNOS-derived endothelial NO is most effective in regulating blood pressure oscillations via modulating the baroreflex mechanisms. The protective action of eNOS on the CVS is emphasized here because dysfunction of the eNOS enzyme is intricately correlated with the pathogenesis of several cardiovascular diseases such as hypertension, arteriosclerosis, myocardial infarction, and stroke. Overall, our current understanding of the eNOS protein with a focus on its role in the modulation, regulation, and control of the cardiovascular system in a normal physiological state and in cardiovascular diseases are discussed.

Public Health Services during the COVID-19 pandemic in 3 European countries: PT, EN and DE

Background

Monitoring and responding to health hazards and emergencies is an Essential Public Health Operation delivered by public health services (PHS) (2). In the European Region, there is a wide range of organizational and financial models for PHS delivery to the populations, but the best approach is still largely unknown (3). This work aims to analyze PHS organization and financing and compare their health results during the COVID-19 pandemic in 3 countries: Portugal, England and Germany.

Methods

We searched The European Observatory on Health Systems and Policies database; GoogleScholar® for the terms “organization” and “financing” associated with PHS and Europe; OurWorldInData® for COVID-19 data.

Results

PHS Organization: PT has national, regional and local units with a top-down decision-making hierarchy, though information flows both ways. EN has the national health system and Public Health England (that supports autonomous local elected health authorities), with independence and little overlapping between them. DE has Federal, State, County and Municipal health actors with self-government and administrative autonomy to a certain degree. Spending on ‘preventing care' as a share of total health expenditure: PT (1,7%), DR (3,2%) and EN (5,1%). COVID-19 cases: DE showed best results while PT and EN were similar.

Conclusions

WHO states the most effective and efficient method of delivering PHS is through an integrated approach, rather than through vertical programmes (2), but PT vertical organization with information flowing both ways and a network of horizontal supporting PH institutions may favor needed coordinated responses during a pandemic. In geographically larger countries, exerting autonomous decisions at different levels may improve preventive measures' efficacy. This analysis adds to the previous literature that suggests the most efficient PHS are adapted to local contexts.

Key messages

The best PHS organization is still unknown, though adaptation to regional and local contexts seems key for better results. Greater spending on “preventive care” does not necessarily guarantee better results, suggesting PHS organization may have a more important role.

Comparing Digital Health Strategies and COVID-19 Response in European Union Member States

Background

In 2019, Digital Health was on the agenda of the European Union (EU) and its Member States (MS), and the digital health transformation of both healthcare services and Public Health has been well underway for several years. The COVID-19 pandemic crisis required an unexpectedly quick adaptation of social norms and exerted great pressure on healthcare and public health systems. Although implemented strategies and results have varied, Digital Health tools emerged as a fundamental aspect of the pandemic fight across the EU.

Methods

The objective of this study was to determine and compare Digital Health Strategies and COVID-19 Response in EU MS 43% had no interoperability with other apps. We analyzed the 27 MS of the EU and determined several parameters relevant before and during the pandemic: 1 - Preexisting national digital health strategy in 2019; 2 - COVID-19 General Information Website; 3 - Real time updated COVID-19 online dashboard; 4 - Mobile application for contact tracing; 4.1 - Mobile app launch date; 4.2 - Interoperability with other mobile apps; 5 - Shift to telemedicine; 6 - Official public health communication through social media; 7 - Dedicated COVID-19 Information System for Public Health Workforce. Information from publicly available sources.

Results

All EU MS had a preexisting digital health strategy before the pandemic, developed a dedicated COVID-19 General Information Website and a COVID-19 dashboard with real-time updates on relevant statistics. The majority of MS (79%) developed a mobile app for contact tracing (43% had no interoperability with other apps), and of those that had not developed an app as of April 30th 2021, 50% had one under development. Most apps were launched in the first trimester of 2021. Other results were heterogeneous.

Conclusions

In some aspects, there is a clear convergence between EU MS in the deployment of digital health tools to fight the COVID-19 pandemic.

Key messages

All European Union Member States used digital health tools to fight the COVID-19 pandemic. The success of national level deployment of specific digital health tools must be assessed in order to develop a more integrated digital health response plan at the European level in the future.

eLiteracy on covid among portuguese women: web-based survey study

Background

Digital tools are recognized public health tools for literacy. Their effectiveness is relatively unknown - some studies describe 40% of adults with literacy levels below the necessary for optimal use. eLiteracy has been a buzzword during the pandemic, but we still don't understand who benefits from it. This study aims to understand the ability of women to identify and use COVID-19 online information and its link with knowledge and behavior

Methods

Web-based survey conducted on female adults. Coronavirus eHealth literacy scales measured skills to apply information (CoV-eHEALHS) and COVID-19−related knowledge, conspiracy beliefs, and adherence to protective behaviors (COVID-19 KAPs). Spearman correlation and Kruskal-Wallis tests were used to identify association between CoV-eHEALHS and COVID-19 KAP, and between these and age, income, and level of education

Results

Higher CoV-eHEALS were seen in higher level of education (χ2=17,03; p = 0,002), higher knowledge (β = 0,19; p = 0,000), lower conspiracy (β=-0,27; p = 0,000) and higher adherence to protective measures (β = 0,24; p = 0,000). Higher knowledge was seen in greater ages (β = 0,11; p = 0,000), higher education (χ2=36,40; p = 0,000) and greater income (χ2=19,96; p = 0,001). Lower conspiracy was seen in higher education (χ2=31,50; p = 0,000) and higher income (χ2=9,71; p = 0,046). Higher adherence to protective measures had no correlation with socioeconomical factors.

Conclusions

There was association between higher eHealth literacy and COVID-19 KAP, reinforcing public health stakeholders to invest on disseminating digital information. There were worse results in younger women of lower education and income, suggesting information should be adapted to this population

Key messages

Digitally disseminated information is important because of the association between higher eHealth literacy and knowledge and protective behavior. It should be adapted for younger women with lower levels of education and income to maximize results.

Intravitreal triamcinolone injections in non-arteritic anterior ischemic optic neuropathy - A retrospective report

BACKGROUND

Non-arteritic anterior ischemic optic neuropathy (NAION) is a common cause of vision loss but no treatment has demonstrated its efficiency. A preliminary study showed an improvement on the visual acuity (VA) in a group of patients who received intravitreal administration of triamcinolone acetonide (IVTA) versus a non-treated group. In the present series, the visual outcome of IVTA in NAION was evaluated on a larger group of patients.

METHODS

This retrospective, unmasked and non-randomized study took place at Reims University Hospital between 2009 and 2017. The data of consecutive patients presenting with isolated optic disc edema characteristic of recent NAION (<1month of visual acuity loss) were included. After informed consent, a single intravitreal injection of filtrated 4mg/0.1mL triamcinolone acetonide were administered. Twenty-seven control patients chose not to be injected and therefore served as controls. LogMar visual acuity (VA), VA rating (VAR) (1 line=0.1LogMAR=5 VAR letters), retinal nerve fiber layer thickness assessed by OCT and static visual field were evaluated at presentation, after 7days, after 3months and after 6months.

RESULTS

Sixty-eight patients with NAION were evaluated. Forty-one received IVTA, 29 were injected within 15days after the onset of symptoms and 12 after 15days. There was a higher proportion of patients improving VA of 2 lines or more (10 or more VAR letters) in the injected group (49%) compared with the non-injected group (11%, P=0.019). Among the patients injected before 15days, the proportion improving for 2 lines or more (55% vs. 11%, respectively, P=0.013) and for 3 lines or more (45% vs. 11%, respectively, P=0.035) were significantly higher than in the non-injected group. Also, comparing the VA at presentation with the VA after 6months in the injected eyes, it improved significantly (P=0.003) and also in the subgroup injected within 15days (P=0.0007) but not in the injected group after 15days (P=0.801). Visual field improvement was only observed in the subgroup of patients injected within 15days with a significant improvement of the mean deviation (dB) within 6months (P=0.015).

CONCLUSIONS

This follow-up study confirms the results of the previous series displaying an apparent benefit of intravitreal steroids injected in the acute phase of NAION. Only patients receiving IVTA within 15days from onset of NAION have a significant improvement of VA and visual field during the follow-up period of 6months.

Instagramming our way through public health communication: why and who is using it?

Background

From disease prevention to health promotion, communication is key for Public Health (PH) practice and, according to the 9th Essential Public Health Operation its goal is to improve populations health literacy and capacity to access, understand and use information. Though social media is frequently presented as a potentially useful tool for PH communication, there is a lack of evidence about its effectiveness and impact on PH outcomes. This study researches Instagram® as a PH tool and aims to know who is using it, what content is shared on the platform and how much engagement there is.

Methods

This cross-sectional study regards information on 1000 Instagram® posts with the hashtags publichealth, publichealthpromotion, healthpromotion, publichealthmatters and publichealtheducation. Authors categorized post content and creators, and reviewed the number of likes and comments per post to determine engagement. Data analysis was performed on IBM SPSS® Statistics.

Results

The most common content categories were communicable diseases (n = 383), non-communicable diseases (n = 258) and healthy lifestyles (n = 143). Health professionals post more about communicable diseases (43,6%) and non-professionals about healthy lifestyles (36,1%). Non-professionals (n = 191) post about PH issues almost as much as health professionals (n = 220) and PH associations (n = 201). Most don't reference their sources (n = 821). Posts on communicable diseases have the most likes and comments per post (mean of 172 likes and 3,1 comments).

Conclusions

Half the Instagram® posts analysed in this study were made by health professionals or organizations. Communicable diseases, non-communicable diseases and healthy lifestyles were the most frequent content categories and had the most engagement. The majority of posts didn't reference their sources. Though Instagram® seems to be a potential PH communication tool, further research is needed to confirm its benefits for PH.

Key messages

Social media platforms like Instagram® are potentially powerful tools for PH communication. There is a need to understand the efficacy of social media as health promotion tools.

What in the world is happening? The numbers behind environmental health

Background

Climate change has made many headlines in the last few years. Because it threatens clean air, safe drinking water, nutritious food supply, and safe shelter, it can have a negative impact on health and undermine any progress on development. The price of inaction is high and the Sustainable Development Goals are a global effort to avoid it. However, Public Health must become a more active player to create greener services to serve a healthier world.

Objective

This presentation aims to provide a historical overview on the evolution of climate change, what we actually know about it, what is its impact on health and the need for green health services.

Results

Human activity since the mid-20th century has largely contributed to rapid climate change, including a rise in average surface temperature (0,9 degrees Celsius), most of which occurred in the past 35 years, and subsequent rise on other extreme events, such as intense rainfalls. Estimations make it that, by 2030, climate change will increase not only the number of deaths by malnutrition, malaria, diarrhoea and heat stress, but also the direct damage costs to health to USD 2-4 billion per year. This not only adds vulnerability to already fragile countries, but also compromises the Sustainable Development Goals. Along that, the healthcare sector is playing a role on generating millions of tons of waste, some of which is toxic, contributing to loss of global habitat and biodiversity and the impairment of the health of the world's ecosystem.

Conclusions

There is enough evidence-based data to support que need for relevant policies or innovative programmes that, besides implementing and advocating for better public health and health systems in each country, can also contribute to the Sustainable Development Goals, namely goals number 7, 8, 11, 12 and 13, and a healthy planet to go along with healthy people.

Cuina sense pares / Cooking without parents

Issue

Health promotion in Catalunya isn't a mandatory competency for councils; hence fomenting healthy eating habits isn't a priority for many municipalities because they have to destiny the resources in required issues. To revert this situation, Barcelona Provincial Council, a second level local administration, gives both technical and economic support for health promotion which is specially needed for municipalities with fewer inhabitants.

Description of the Problem

Adolescence implies autonomy to eat and often it turns in unhealthy eating habits. For this reason, Barcelona Provincial Council, in 2010 creates the project “Cuina sense pares” to promote a healthy eating and an optimum nutritional state from 14 to 18 teenagers in the province of Barcelona. The project counts on cooking workshops throughout territory and on a website www.cuinasensepares.cat that facilitates resources and cooking proposals adapted to the collective.

Questions

What was the response of the municipalities in the project? How municipalities value the project? Has it been echoed in the media?

Results

In 10 years, 673 workshops have been realised in 154 municipalities from the 311 in the province of Barcelona with a participation of 9.069 teenagers. Additionally, a 60% of the applicant municipalities have less than 10.000 inhabitants. The municipal technicians have rated the cooking workshops with an average of 9.11 among all. It has appeared 126 times in news media. In addition, the website has had more than 94.000 views and the Youtube channel has had 33.400.

Lessons

Involve the young in their eating by the elaboration of easy and healthy recipes. As an innovation, healthy cooking workshops are offered to municipalities complemented by a website.

Key messages

Facilitate tools to municipalities to boost healthy promotion eating programmes between the young. Foment a healthy eating between the young by attractive cooking proposals.

Intra- and Extra-articular Features of Temporomandibular Joint Ankylosis in the Cat (Felis catus)

Temporomandibular joint (TMJ) ankylosis is an uncommon clinical entity in human and veterinary medicine. However, the condition is severely debilitating and is life-limiting if not treated. This study sought to characterize the intra- and extra-articular features of naturally occurring TMJ ankylosis in cats. TMJs from client-owned cats (n = 5) that underwent bilateral TMJ gap arthroplasty were examined and compared with TMJs from healthy, age-matched feline cadavers (n = 2) by cone-beam computed tomography (CBCT), micro-computed tomography (μCT) and histologically. Features of bilateral intra- and extra-articular ankylosis compounded by degenerative joint lesions were identified radiographically and histologically in all affected cats. Features of TMJ 'true' ankylosis included variable intracapsular fibro-osseous bridging, degeneration of the disc and the articular surfaces, narrowing of the joint space and flattening of the condylar process of the mandible. Extra-articular features of TMJ ankylosis included periarticular bone formation and fibro-osseous bridging between the mandible, zygomatic arch and coronoid process. In addition, subchondral bone loss or sclerosis, irregular and altered joint contours and irregularly increased density of the medullary bone characterized the degenerative changes of the osseous components of the TMJ. Complex radiological and histological features of both ankylosis and pseudoankylosis were identified that clinically manifested in complete inability to open the mouth.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

The Kalanchoë genome provides insights into convergent evolution and building blocks of crassulacean acid metabolism

Crassulacean acid metabolism (CAM) is a water-use efficient adaptation of photosynthesis that has evolved independently many times in diverse lineages of flowering plants. We hypothesize that convergent evolution of protein sequence and temporal gene expression underpins the independent emergences of CAM from C3 photosynthesis. To test this hypothesis, we generate a de novo genome assembly and genome-wide transcript expression data for Kalanchoë fedtschenkoi, an obligate CAM species within the core eudicots with a relatively small genome (~260 Mb). Our comparative analyses identify signatures of convergence in protein sequence and re-scheduling of diel transcript expression of genes involved in nocturnal CO2 fixation, stomatal movement, heat tolerance, circadian clock, and carbohydrate metabolism in K. fedtschenkoi and other CAM species in comparison with non-CAM species. These findings provide new insights into molecular convergence and building blocks of CAM and will facilitate CAM-into-C3 photosynthesis engineering to enhance water-use efficiency in crops.

Effects of oral exposure to silver nanoparticles on the sperm of rats

It has been demonstrated that exposure to silver nanoparticles (AgNPs) can induce toxicological effects in rodents. In this study, we investigated whether sub-chronic oral exposure to different doses of polyvinil pyrrolidone (PVP)-coated AgNPs (PVP-AgNPs) (50, 100 and 200mg/kg/day) could induce harmful effects on epididymal sperm rat parameters. Sperm motility, viability and morphology were examined. Moreover, a histological evaluation of testis and epididymis was also performed. High doses of PVP-AgNPs showed higher sperm morphology abnormalities, while a progressive, but not significant effect, was observed in other sperm parameters. The current results suggest that oral sub-chronic exposure to PVP-AgNPs induces slight toxicological effects in sperm rat parameters.

A roadmap for research on crassulacean acid metabolism (CAM) to enhance sustainable food and bioenergy production in a hotter, drier world

Crassulacean acid metabolism (CAM) is a specialized mode of photosynthesis that features nocturnal CO2 uptake, facilitates increased water-use efficiency (WUE), and enables CAM plants to inhabit water-limited environments such as semi-arid deserts or seasonally dry forests. Human population growth and global climate change now present challenges for agricultural production systems to increase food, feed, forage, fiber, and fuel production. One approach to meet these challenges is to increase reliance on CAM crops, such as Agave and Opuntia, for biomass production on semi-arid, abandoned, marginal, or degraded agricultural lands. Major research efforts are now underway to assess the productivity of CAM crop species and to harness the WUE of CAM by engineering this pathway into existing food, feed, and bioenergy crops. An improved understanding of CAM has potential for high returns on research investment. To exploit the potential of CAM crops and CAM bioengineering, it will be necessary to elucidate the evolution, genomic features, and regulatory mechanisms of CAM. Field trials and predictive models will be required to assess the productivity of CAM crops, while new synthetic biology approaches need to be developed for CAM engineering. Infrastructure will be needed for CAM model systems, field trials, mutant collections, and data management.

Predictors of severity in deep neck infections admitted to the intensive care unit

A retrospective study was performed on adult patients admitted for surgical drainage of deep neck infections and admitted to the intensive care unit (ICU) during a period of 52 months. Severe infection was defined as septic shock/severe sepsis, mediastinitis, empyema or necrotising fasciitis. Complicated course was defined as ICU stay >8 days, reintubation, tracheostomy, renal replacement therapy, critical illness, myopathy or mortality. Chi-square or Fisher's exact test were used to assess differences and the significance level was controlled for multiple comparisons applying Bonferroni's correction. Fifty-four patients were studied. Variables associated with severe infection (43%) were abscess location (retropharyngeal [52 vs 7%; P<0.001] or multiple [52 vs 13%; P=0.002]), Acute Physiology and Chronic Health Evaluation II>7 (78 vs 13%; P<0.001), Simplified Acute Physiology Score II>29 (73 vs 21%; P<0.001) and first ICU day Sequential Organ Failure Assessment score>2 (77 vs 21%; P<0.001). Variables associated with complicated course (56%) were: parapharyngeal location (60 vs 8%; P<0.001)], Acute Physiology and Chronic Health Evaluation II>7 (67 vs 14%; P=0.001), Simplified Acute Physiology Score II>29 (62 vs 18%; P=0.002) and Sequential Organ Failure Assessment score>2 (68 vs 17%; P<0.001). Serious complications occur frequently in patients with deep neck infections surgically drained and admitted to the ICU. Higher severity scores are associated with both severe infection and a complicated course. Retropharyngeal and parapharyngeal locations are associated with severe infection and a complicated course respectively.

Growth of Vibrio anguillarum in Salmon Intestinal Mucus

The physiological changes of Vibrio anguillarum in response to growth in salmon intestinal mucus were investigated. Growth, survival, and changes in protein expression during growth in media supplemented with mucus were compared to growth and starvation in the identical media without mucus. V. anguillarum exhibited a rapid decline in CFU following growth in mucus as the sole carbon source. No such decline was observed in Luria broth with a 2% NaCl concentration, in glucose-minimal broth (3M), or during starvation in a carbon-, nitrogen-, and phosphorus-free salt solution (NSS). The changes in protein expression during growth in mucus were examined by labeling cells with [(sup35)S]methionine and analyzing the labeled proteins by one- and two-dimensional gel electrophoresis and autoradiography. Comparison of [(sup35)S]methionine-labeled proteins from mucus-grown cells with 3M-grown cells and NSS-starved cells revealed four de novo mucus-inducible proteins (Mips). These Mips were localized in the membrane fraction of V. anguillarum. Additionally, at least one other membrane protein was found to have increased expression in response to growth in mucus.