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Abstract Dispersal is an important life history trait that plays a key role in the demography and evolution of species. We employed a combined approach of DNA sequencing and transmission electron microscopy to examine the changes in the microbiome during the ontogeny and dispersal of the coral-excavating sponge Thoosa mismalolli. The results show that sponge can acquired their associated bacteria via both vertical (VT) and horizontal transmission (HT). Adult sponges, brooding larvae, and early free-swimming sponge larvae harbor a similar high-diversity microbial assemblage, dominated by Proteobacteria and Chloroflexi, which change throughout the larval dispersal phase. Larvae collected offshore showed a reorganization of their microbiome with a significant reduction of the dominance of inherited bacteria (Proteobacteria and Chloroflexi), and an enrichment of environmentally derived bacteria taxa (Bacteroidetes, Tenericutes, and Firmicutes). TEM confirmed a substantial change in cell structure and microbial composition, attributed to symbionts’ massive phagocytosis. This research provides information on microbiome dynamics through the sponge ontogeny and sheds on their possible role in the dispersal capacity of their larvae.

BackgroundClinical trials are known to provide cause-and-effect results and data with low levels of bias. However, a lack of funding for clinical trials, which are considered expensive, means that academic sponsors are rarely able to conduct them. Academic trials are considered highly relevant for the valuable results they provide for clinical questions. This is why initiatives to conduct unfunded clinical trials have been identified as an important issue to pay attention to in future studies. Therefore, we present our initiative through Rogers’ theory, which is highlighted in the literature for diffusing innovative change across organizations. ObjectiveThe purpose of this paper was to describe our case regarding management for conducting a nonfunded nurse-led clinical trial based on our previous low-interventional clinical trial across a specific health organization and with nurses. MethodsWe conducted a low-intervention, nonexternally funded clinical trial using the human and material resources available on site. We managed our trial in a clinical trial unit where there were staff, sources, and ongoing commercial clinical trials. We conducted our trial based on an ongoing commercial trial, and, to do so, we needed behavioral changes. We relied on Rogers’ theory, and we identified strengths and barriers to change by analyzing actors' characteristics, perceptions of the situation, motivation, and information. Afterward, we divided the staff according to their characteristics related to innovation and change into permanent staff (research staff with a culture of change) and nonpermanent staff (nursing staff with occasional attendance and resistance to change). First, we preselected only those nurses who were more aware of change (innovators and pioneers) to participate in our trial to avoid a massive rejection, and later, we asked others to join (late adopters). We followed Rogers’ phases. For research staff who were aware of the funding, we focused on the “persuasion phase,” while for nursing staff, we mixed the “knowledge and persuasion phases” and used pioneers and early adopters as a positive example for other nurses as well as nonfinancial incentives (persuasion). Our trial consisted of different methods of vein cannulation, which was performed in the ongoing commercial trial. Thus, the entire development of our low-interventional clinical trial was conducted without interfering at any point with the parallel commercial clinical trial. ResultsOur management allowed effective conduct of our study, and we met our aims without external funding and without ethical impact during the commercial clinical trial. Costs remained low, primarily because the major expenses were covered by the commercial clinical trial as an inherent part of its design. ConclusionsOur initiative to conduct a low-intervention clinical trial with no or limited funding was cost-effective. This initiative can be used by researchers with valuable academic research questions who do not have the external funding to conduct studies. Trial RegistrationClinicalTrials.gov NCT04027218; https://clinicaltrials.gov/study/NCT04027218 International Registered Report Identifier (IRRID)RR1-10.2196/56062

BackgroundHealth Promoting Schools (HPS) have emerged as a powerful framework to promote healthy behaviors in many countries. However, HPS still present several challenges, highlighting the excessive workload involved in the accreditation, design, implementation, and evaluation processes. In this sense, a resource to facilitate the implementation processes may have a positive impact on the support of HPS. ObjectiveThe aim of this study was to describe the co-design processes undertaken and resulting learnings to develop the Red Escuelas Promotoras de Salud (network of health promoting schools; REDEPS)-Gestion platform to facilitate the accreditation, design, implementation procedures, and evaluation processes of the Aragon's Health-Promoting School Network. MethodsThe Double Diamond Design Approach was used to co-design this web-platform. The different stakeholders that participated in this co-design, progressed through a 4-stage reflective phase, to discover, define, develop, and deliver the REDEPS-Gestion platform. ResultsParticipants agreed that the functions of the REDEPS-Gestion platform should permit the management of both the educational centers and the administration such as accreditation processes, definition and review intervention projects, and preparation and review of the different progress reports to evaluate the HPS. Despite co-design being a well-established approach to creative practice, especially within the public sector, some challenges emerged during the co-design process, such as engaging and facilitating stakeholders’ participation or the complexity of combining the interests of all stakeholders. This approach allowed us to identify the main barriers for future users and implement platform improvements. ConclusionsWe hope that the REDEPS-Gestion platform will therefore be able to contribute to facilitating the implementation of HPS. The Double Diamond Design Approach used to co-design this web platform was an efficient and feasible methodological design approach. The REDEPS-Gestion platform will facilitate HPS implementation in Aragon as well as all the processes involving HPS. Future work will determine its effectiveness in improving HPS implementation. International Registered Report Identifier (IRRID)DERR1-10.2196/52110

Abstract Background Mindfulness-based interventions (MBIs) appear to be effective for improving the mental health of healthcare professionals (HCPs). However, the effectiveness of MBIs on extreme psychological trauma caused by the coronavirus disease 2019 (COVID-19) pandemic is largely unknown. The aim of this paper was to systematically review empirical studies of MBIs for HCPs carried out during the COVID-19 pandemic, to evaluate them and their effectiveness in different areas of mental health. Methods The electronic databases searched were Web of Science, Scopus, PubMed, and PsycINFO. The date when each database was last searched was September 15, 2023. Randomized controlled trials (RCTs), non-randomized controlled trials (NRCTs), and non-randomized non-controlled trials (NRNCTs) focused on MBIs for health care staff who were working in healthcare centers during the COVID-19 pandemic were included. All of them employed standardized measures of mental health. The review followed the best practices and reported using PRISMA guidelines. A data collection form, adapted from the Cochrane handbook for systematic reviews of interventions, was used to extract and synthesize the results. The methods used to assess the risk of bias in the included studies were the Cochrane Risk of Bias Tool and the ROBINS-I Tool. Results Twenty-eight studies were included in the systematic review. Overall, the methodological quality of the studies was moderate. The results showed the effectiveness of MBIs in improving levels of stress, mindfulness, and mental well-being. However, no conclusive results were found regarding the effectiveness of MBIs in improving the levels of burnout, anxiety, depression, sleep quality, and resilience of HCPs. Conclusions The MBIs for HCPs carried out during the COVID-19 pandemic have mainly contributed to improving stress, mindfulness, and mental well-being at a time of serious health emergency. However, more robust studies at a methodological level would have been desirable. Systematic review registration PROSPERO CRD42021267621

Abstract Both HIV-1 infection and smoking may contribute to the development of ageing-related manifestations affecting the prognosis of people living with HIV, but it is unclear whether HIV and smoking exert their effects independently or interact by potentiating each other. We conducted a cross-sectional study in 192 people living with HIV aged- and gender-matched with 192 HIV-uninfected controls, assessing the relative effect of HIV-1/smoking status on lung function (FEV1), bone mineral density (BMD), appendicular skeletal muscle mass index (ASMI), aortic pulse-wave velocity (PWV), insulin resistance (HOMA-IR) and renal function. In both unadjusted and adjusted analyses, FEV1, BMD and ASMI significantly differed according to smoking/HIV status, with the worst parameters found in HIV-1 infected patients currently smoking, and BMD and ASMI decreased to a lesser extent in HIV-1 infected patients formerly smoking (> 10 pack-years). Values in people living with HIV with

ABSTRACT Introduction and objectives: Invasive diagnosis of vasoreactivity and microvascular function may be useful to optimize the management of patients with signs and/or symptoms of myocardial ischemia in the absence of significant coronary stenosis (INOCA). We analyzed the prevalence of the different endotypes, as well as the concordance between 2 diagnostic methods based on thermodilution assessment. Methods: We prospectively included 60 patients with INOCA who underwent a vasoreactivity test with intracoronary acetylcholine, and measurement of absolute coronary blood flow (Q) and minimum microvascular resistance (R) using continuous thermodilution assessment. Finally, calculations of the coronary flow reserve (CFR) and index of microcirculatory resistance index (IMR) were made using the bolus thermodilution method considering CFR 435 UW was estimated as the optimal cut-off value to identify patients with IMR ≥ 25 with an area under the curve of 0.67 (95%CI, 0.51-0.82; P = .04). Conclusions: The invasive study of vasoreactivity and microcirculation was feasible and safe. Prevalence of vasospasm and microvascular dysfunction in patients with INOCA was high. The CFR/MRI/Q combined study allowed us to unmask a subtype of microvascular dysfunction characterized by an abnormally high coronary flow at baseline. The concordance seen between the microvascular resistance obtained by continuous thermodilution measurements and the reference method was low so future studies are justified to determine the usefulness of this technique.

Abstract Sensitisation to the lipid transfer protein Pru p 3 is associated with severe allergic reactions to peach, the proteins stability being thought to play a role in its allergenicity. Lipid binding increases susceptibility of Pru p 3 to digestion and so the impact of bile salts on the in vitro gastrointestinal digestibility of Pru p 3 was investigated and digestion products mapped by SDS-PAGE and mass spectrometry. Bile salts enhanced the digestibility of Pru p 3 resulting in an ensemble of around 100 peptides spanning the protein’s sequence which were linked by disulphide bonds into structures of ~ 5–6 kDa. IgE binding studies with a serum panel from peach allergic subjects showed digestion reduced, but did not abolish, the IgE reactivity of Pru p 3. These data show the importance of including bile salts in vitro digestion systems and emphasise the need to profile of digestion in a manner that allows identification of immunologically relevant disulphide-linked peptide aggregates.

ObjectiveTo analyse the interrater reliability of the NEUMOBACT checklist and verify whether consistent results are reproducible.MethodsA validation study with a cross-sectional design, compliant with the GRRAS checklist, among ICU nurses attending a SIMULAZERO course with an Objective Structured Clinical Evaluation simulation format, to verify transfer from theory to clinical practice of knowledge and skills in ventilator-associated pneumonia (VAP) and catheter-related bacteraemia (CRB) prevention. A minimum sample size of 111 pairs of nurse raters was calculated. Interrater agreement was analysed using Gwet's AC1 for each item and as a total for each of the three checklists in the NEUMOBACT instrument.ResultsA total of 95 pairs of valid NEUMOBACT checklists were completed by 190 raters with a median age of 29 [25-35] years, 93.7% were female. At the Central Venous Catheter insertion station, Gwet's AC1 was 0.934 (95% CI [0.919-0.949]). Only 2 of the 17 items scored below 0.9. At the Endotracheal Suctioning station, Gwet's AC1 was 0.869 (95% CI [0.851-0.886]). Of the 26 items that made up this station, 16 had an agreement percentage above 0.9, a further 9 were between 0.821 and 0.884, and item 13 had a value of 0.789. At the Patient Care station, Gwet's AC1 was 0.911 (95% CI [0.896-0.927]). Of the 21 items, 17 showed an agreement percentage above 0.9 and 4 were between 0.810 and 0.894.ConclusionsThe interrater reliability of the NEUMOBACT checklist shows substantial agreement between pairs of raters and is therefore validated in this large sample of ICU nurses.Relevance to clinical practiceThe NEUMOBACT checklist can be useful for assessing skills before and after training in VAP and CRB prevention measures and during debriefing (post-simulation feedback), to reinforce the scientific evidence behind actions and decisions for items that have been performed incorrectly, thus consolidating training already received.

ObjectiveThe aim is to examine whether the addition of Virtual Reality (VR) meditation training to a standard 8-week Mindfulness-Based Health Care Program (MBHC-VR) results in a significantly increased improvement in occupational, mental health, and psychological functioning versus MBHC-only in university students.Materials and methodsA randomized controlled clinical trial with three arms (MBHC, MBHC-VR, Control Group), four assessment time points (pre-intervention, inter-session, post-intervention, and 3-month follow-up), and mixed methodology will be proposed. University students (undergraduate, master, or doctoral) interested in participating and who meet the inclusion/exclusion criteria will be included over two years. Data will be collected from different ad hoc questionnaires, several standardized tests, and an Ecological Momentary Assessment. We will use R software to carry out descriptive analyses (univariate and bivariate), multilevel modeling, and structural equation models to respond to the proposed objective. The qualitative analysis will be carried out using the MAXQDA program and the technique of focus groups.DiscussionIt is expected that with the proposed intervention university students will learn to relate in a healthier way with their mental processes, so as to improve their occupational balance (OB) and their psychological well-being.Trial registrationClinicalTrials.gov Identifier NCT05929430.

Abstract Background The Mediterranean diet has been associated with lower risk of breast cancer (BC) but evidence from prospective studies on the role of Mediterranean diet on BC survival remains sparse and conflicting. We aimed to investigate whether adherence to Mediterranean diet prior to diagnosis is associated with overall and BC-specific mortality. Methods A total of 13,270 incident breast cancer cases were identified from an initial sample of 318,686 women in 9 countries from the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Adherence to Mediterranean diet was estimated through the adapted relative Mediterranean diet (arMED), a 16-point score that includes 8 key components of the Mediterranean diet and excludes alcohol. The degree of adherence to arMED was classified as low (score 0–5), medium (score 6–8), and high (score 9–16). Multivariable Cox proportional hazards models were used to analyze the association between the arMED score and overall mortality, and Fine-Gray competing risks models were applied for BC-specific mortality. Results After a mean follow-up of 8.6 years from diagnosis, 2340 women died, including 1475 from breast cancer. Among all BC survivors, low compared to medium adherence to arMED score was associated with a 13% higher risk of all-cause mortality (HR 1.13, 95%CI 1.01–1.26). High compared to medium adherence to arMED showed a non-statistically significant association (HR 0.94; 95% CI 0.84–1.05). With no statistically significant departures from linearity, on a continuous scale, a 3-unit increase in the arMED score was associated with an 8% reduced risk of overall mortality (HR3-unit 0.92, 95% CI: 0.87–0.97). This result sustained when restricted to postmenopausal women and was stronger among metastatic BC cases (HR3-unit 0.81, 95% CI: 0.72–0.91). Conclusions Consuming a Mediterranean diet before BC diagnosis may improve long-term prognosis, particularly after menopause and in cases of metastatic breast cancer. Well-designed dietary interventions are needed to confirm these findings and define specific dietary recommendations.

Resumen: Introducción y objetivos: La quinasa ligada a integrina (ILK) endotelial controla la producción del óxido nítrico, modulando señales de transducción al interior celular. La disminución de ILK endotelial se ha relacionado con la calcificación valvular. Analizamos la asociación de la ILK con la calcificación de la válvula aórtica. Métodos: Estudio observacional, unicéntrico y prospectivo. Recogimos tejido valvular aórtico de pacientes intervenidos de estenosis aórtica, y controles de válvulas no calcificadas. Cuantificamos los niveles de ILK endotelial empleando técnicas de análisis molecular, así como marcadores de crecimiento óseo (BMP2 y RUNX2). Para el control de factores de confusión empleamos regresión logística múltiple por pasos, introduciendo parámetros relacionados con la aterosclerosis y calcificación valvular (edad, DM, HTA, insuficiencia renal). Resultados: Obtuvimos muestras de 75 pacientes y 28 controles. El 69,9% eran varones, la edad media fue de 67 años (DE 9,59 años). Los niveles de ILK fueron significativamente más bajos en válvulas patológicas que en controles (0,96 vs. 0,76; p

Background Litsea glaucencens Kuth is an aromatic plant used for food seasoning food and in Mexican traditional medicine. Among, L. glaucencens leaves properties, it has proven antibacterial activity which can be used against opportunistic pathogens like Listeria monocytogenes, a foodborne bacteria that is the causal agent of listeriosis, a disease that can be fatal in susceptible individuals. The aim of this work was to investigate the antibacterial activity of L. glaucescens Kuth leaf extracts against L. monocytogenes and to identify its bioactive components. Material and Methods L. glaucences leaves were macerated with four solvents of different polarity (n-hexane, dichloromethane, ethyl acetate, and methanol). To determine the capacity to inhibit bacterial proliferation in vitro, agar diffusion and microdilution methods were used. Next, we determined the minimal bactericidal concentration (MBC). Finally, we determined the ratio of MBC/MIC. Metabolites present in the active methanolic extract from L. glaucescens Kuth (LgMeOH) were purified by normal-phase open column chromatography. The structure of the antibacterial metabolite was determined using nuclear magnetic resonance (1H, 13C, COSY, HSQC) and by comparison with known compounds. Results The LgMeOH extract was used to purify the compound responsible for the observed antimicrobial activity. This compound was identified as 5,7-dihydroxyflavanone (pinocembrin) by analysis of its spectroscopic data and comparison with those described. The MIC and MBC values obtained for pinocembrin were 0.68 mg/mL, and the ratio MBC/MIC for both LgMeOH and pinocembrin was one, which indicates bactericidal activity. Conclusion L. glaucences Kuth leaves and its metabolite pinocembrin can be used to treat listeriosis due the bactericidal activity against L. monocytogenes.

Background: intrauterine growth retardation has significant implications for neonatal morbidity and mortality. Objective: characterize the cases of intrauterine growth restriction identified in the Las Tunas province, in the period from January to December 2020. Methods: an observational, descriptive cross-sectional study was conducted in the province of Las Tunas from January 2020 to December 2020, which included 607 live newborns with a weight of less than 10 percentile for their gestational age and sex. The variables studied were: municipalities of origin, gestational age, sex, classification of intrauterine growth restriction, maternal age, twins, prematurity and birth weight. Results: of the 5022 live births in the study period, 607 presented intrauterine growth restriction, for a prevalence of 12.1 per 100 live births. 35.4 % of children with intrauterine growth had low birth weight and 14.7 % were preterm. Of the 607 neonates with intrauterine growth, six died, for a lethality of 0.99% and a survival rate of 99.01 %. Conclusions: in this study, Amancio, Menendez and Majibacoa municipalities showed the highest prevalence and high risk of intrauterine growth. Females prevailed, gestational age over 32 weeks and moderate intrauterine growth. Maternal age below 18 years and above 35 years influenced the appearance of intrauterine growth, while prematurity and weight below 3 percentile affected the mortality of these children.

Biological matrices are typically used in forensic toxicological or pharmacological analysis: mainly blood, vitreous humor or urine. However, there are many cases in which crimes are a consequence of drug intoxication or drug abuse and they are not closed because over the months or years the samples become altered or decomposed. A dried blood stains test (DBS-MS) has recently been proposed to be used in drug toxicology when blood is found at a crime scene. This test could help an investigator to reveal what a person had consumed before the perpetration of the crime. In order to check the possibilities of this test, we analyzed several dried blood stains located on a cotton fabric. Therefore, the aim of this study was to determine if the analysis of a dried blood spot located on a cotton fabric could be an alternate source of obtaining toxicological results, particularly regarding benzodiazepines. We splashed blood stains on cotton fabric with different concentrations of the following benzodiazepines: alprazolam, bromazepam, clonazepam, diazepam and lorazepam, which were dried for 96 h and subsequently quantified by high-performance liquid chromatography coupled mass spectrometry (HPLC-MS). Our results show that it is possible to identify several benzodiazepines contained in a cotton fabric blood stain; consequently, this method may add another sample option to the toxicological analysis of biological vestiges found at a crime scene.

Tacrolimus (Tac) is pivotal in preventing acute graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (alloHSCT). It has been reported that genetic factors, including CYP3A5*3 and CYP3A4*22 polymorphisms, have an impact on Tac metabolism, dose requirement, and response to Tac. There is limited information regarding this topic in alloHSCT. The CYP3A5 genotype and a low Tac trough concentration/dose ratio (Tac C0/D ratio) can be used to identify fast metabolizers and predict the required Tac dose to achieve target concentrations earlier. We examined 62 Caucasian alloHSCT recipients with a fast metabolizer phenotype (C0/dose ratio ≤ 1.5 ng/mL/mg), assessing CYP3A5 genotypes and acute GVHD incidence. Forty-nine patients (79%) were poor metabolizers (2 copies of the variant *3 allele) and 13 (21%) were CYP3A5 expressers (CYP3A5*1/*1 or CYP3A5*1/*3 genotypes). CYP3A5 expressers had lower C0 at 48 h (3.7 vs. 6.2 ng/mL, p = 0.03) and at 7 days (8.6 vs. 11.4 ng/mL, p = 0.04) after Tac initiation, tended to take longer to reach Tac therapeutic range (11.8 vs. 8.9 days, p = 0.16), and had higher incidence of both global (92.3% vs. 38.8%, p < 0.001) and grade II-IV acute GVHD (61.5% vs. 24.5%, p = 0.008). These results support the adoption of preemptive pharmacogenetic testing to better predict individual Tac initial dose, helping to achieve the therapeutic range and reducing the risk of acute GVHD earlier.

Abstract Hypertension is a public health issue that can have its origin in the early phases of development. Maternal smoking during pregnancy (MSDP) could play a role in offspring’s cardio-metabolic programming. To assess the relationship between MSDP and later blood pressure (BP) in children we conducted a secondary analysis of a randomized dietary intervention trial (EU-Childhood Obesity Project). Healthy term infants with normal birth weight were recruited during the first 8 weeks of life in 5 European countries and followed until 11 years of age. Data on MSDP was collected at recruitment. BP and anthropometry were assessed at 11 years of age. Children were classified according to AAP guidelines as normal BP: BP 95th percentile categorized as hypertensive. Out of 572 children, 20% were exposed to MSDP. At 11 years, 26.8% had BP over the 90th centile. MSDP beyond 12 weeks of gestation was associated with higher systolic BP percentile (adjusted B 6.935; 95% CI 0.454, 13.429; p = 0.036) and over twofold increase likelihood of hypertension (OR 2.195; 95% CI 1.089, 4.423; p = 0.028) in children at 11 years. MSDP was significantly associated with later BP in children.

Abstract The epidemiological association between exposure to particulate matter (PM10) and various respiratory and cardiovascular problems is well known, but the mechanisms driving these effects remain unclear. Neutrophils play an essential role in immune defense against foreign agents and also participate in the development of inflammatory responses. However, the role of these cells in the PM10 induced inflammatory response is not yet fully established. Thus, this study aims to evaluate the effect of PM10 on the neutrophil-mediated inflammatory response. For this, neutrophils from healthy adult human donors were in vitro exposed to different concentrations of PM10. The cell viability and cytotoxic activity were evaluated by MTT. LDH, propidium iodide and reactive oxygen species (ROS) were quantified by flow cytometry. Interleukin 8 (IL-8) expression, peptidyl arginine deiminase 4 (PAD4), myeloperoxidase (MPO), and neutrophil elastase (NE) expression were measured by RT-PCR. IL-8 was also quantified by ELISA. Fluorescence microscopy was used to evaluate neutrophil extracellular traps (NETs) release. The in vivo inflammatory responses were assessed in BALB/c mice exposed to PM10 by histopathology and RT-PCR. The analysis shows that PM10 exposure induced a cytotoxic effect on neutrophils, evidenced by necrosis and LDH release at high PM10 concentrations. ROS production, IL-8, MPO, NE expression, and NETs release were increased at all PM10 concentrations assessed. Neutrophil infiltration in bronchoalveolar lavage fluid (BALF), histopathological changes with inflammatory cell infiltration, and CXCL1 expression were observed in PM10-treated mice. The results suggest that lung inflammation in response to PM10 could be mediated by neutrophils activation. In this case, these cells migrate to the lungs and release pro-inflamatory mediators, including ROS, IL-8, and NETs. Thus, contributing to the exacerbation of respiratory pathologies, such as allergies, infectious and obstructive diseases.

The COVID-19 pandemic represents a global health problem, which has been mitigated by the opportune introduction of vaccination programs. Although we already know the benefit that vaccines provide, these are not exempt from adverse events which can be mild to deadly, such as idiopathic inflammatory myopathies, in which a temporal association has not been defined. It is for this reason that we carried out a systematic review of all reported cases of vaccination against COVID-19 and myositis. To identify previously reported cases of idiopathic inflammatory myopathies associated with vaccination against SARS-CoV-2 we registered this protocol on the website of PROSPERO with identification number CRD42022355551. Of the 63 publications identified in MEDLINE and 117 in Scopus, 21 studies were included, reporting 31 cases of patients with vaccination-associated myositis. Most of these cases were women (61.3%); mean age was 52.3 years (range 19-76 years) and mean time of symptom onset post-vaccination was 6.8 days. More than half of the cases were associated with Comirnaty, 11 cases (35.5%) were classified as dermatomyositis, and 9 (29%) as amyopathic dermatomyositis. In 6 (19.3%) patients another probable trigger was identified. Case reports of inflammatory myopathies associated with vaccination have heterogeneous presentations without any specific characteristics: as a consequence, it is not possible to ensure a temporal association between vaccination and the development of inflammatory myopathies. Large epidemiological studies are required to determine the existence of a causal association.

BackgroundCerebral palsy is the most common brain injury in the pediatric population. Patients with cerebral palsy present different affectations such as decreased muscle strength, gait deviations, impaired proprioception, and spasticity. Isokinetic strengthening programs combined with intensive rehabilitation may improve muscle strength and therefore gait efficiency. ObjectiveThe primary aim of this randomized controlled trial is to compare the effect of an intensive rehabilitation combined with a nonfunctional isokinetic progressive strengthening program to an intensive rehabilitation alone on gait parameters and muscle strength in patients with cerebral palsy. Another goal of this study is to determine whether adding an isokinetic program to intensive rehabilitation is more effective than intensive rehabilitation alone at decreasing spasticity and improving joint position sense in patients with cerebral palsy. MethodsA total of 30 adolescents with spastic diplegia cerebral palsy (Gross Motor Function Classification System levels I to III) will be randomized, by an independent researcher, into a 3-week intensive rehabilitation and isokinetic progressive strengthening group or an intensive rehabilitation control group. Gait parameters, muscle strength, spasticity, and knee joint position sense will be assessed. These variables will be evaluated at baseline (T0) and at the end of the intervention (T1). The intensive rehabilitation will consist of physiotherapy sessions twice a day and hydrotherapy and virtual reality gait training once a day. The isokinetic training group will have a total of 9 supervised isokinetic strength training sessions focusing on knee flexors and extensors with different execution speeds. ResultsThe protocol has been accepted by the French National Ethics Committee in October 2022. The inclusion of patients will start in November 2022. ConclusionsThe combination of intensive rehabilitation with an isokinetic program on knee flexors and extensors has not been studied yet. The findings of this study may determine if an isokinetic strength training program of knee flexors and extensors is beneficial for the improvement of gait parameters, muscle strength, spasticity, and joint position sense in adolescents with spastic diplegia. International Registered Report Identifier (IRRID)PRR1-10.2196/43221

The brown alga Sargassum provides a natural substrate occupied by hydrozoans in shallow marine waters. A global count in 2007 listed 39 epibiotic species of Hydrozoa growing on Sargassum, but more studies have been published since, therefore, an update is timely, particularly due to the increased abundance of Sargassum in the Caribbean. This review, based on a recent literature survey and new records from Mexico, includes 133 publications of epibiotic hydrozoans on Sargassum spanning 220 years, from 1802 to 2022. A total of 131 hydrozoan species were recorded on 26 species of Sargassum, most belonging to the subclass Hydroidolina (130), with only one record of a trachyline medusa (Gonionemus vertens, subclass Trachylinae). Most publications centered on the Tropical Atlantic, where the greatest number of hydrozoan species (67 species) were recorded. All hydrozoan species possess a hydrorhiza, except one hydromedusae species that attach to Sargassum via adhesive tentacles. Most of the hydrozoan species associated with Sargassum exhibited a benthic life cycle (93 species) and are comprised of erect, branched colonies (67 species) and large hydrothecae (69 species). Although the number of studies of epibiotic hydrozoans on Sargassum has increased since the mid-20th century, nevertheless hydrozoan richness has not reached an asymptote. Therefore, more sampling of Sargassum species would likely identify more hydrozoan species associated with Sargassum, especially among benthic Sargassum, and might help reveal potential biogeographical and ecological patterns between Sargassum and hydrozoan epibionts.

ObjectiveTo assess the incidence and determinants of ICU-acquired muscle weakness (ICUAW) in adult patients with enteral nutrition (EN) during the first 7 days in the ICU and mechanical ventilation for at least 48 hours.MethodsA prospective, nationwide, multicentre cohort study in a national ICU network of 80 ICUs. ICU patients receiving invasive mechanical ventilation for at least 48 hours and EN the first 7 days of their ICU stay were included. The primary outcome was incidence of ICUAW. The secondary outcome was analysed, during days 3-7 of ICU stay, the relationship between demographic and clinical data to contribute to the onset of ICUAW, identify whether energy and protein intake can contribute independently to the onset of ICUAW and degree of compliance guidelines for EN.Results319 patients were studied from 69 ICUs in our country. The incidence of ICUAW was 153/222 (68.9%; 95% CI [62.5%-74.7%]). Patients without ICUAW showed higher levels of active mobility (p = 0.018). The logistic regression analysis showed no effect on energy or protein intake on the onset of ICUAW. Overfeeding was observed on a significant proportion of patient-days, while more overfeeding (as per US guidelines) was found among patients with obesity than those without (42.9% vs 12.5%; pConclusionsThe incidence of ICUAW was high in this patient cohort. Early mobility was associated with a lower incidence of ICUAW. Significant overfeeding and deficient protein intake were observed. However, energy and protein intake alone were insufficient to explain ICUAW onset.Relevance to clinical practiceLow mobility, high incidence of ICUAW and low protein intake suggest the need to train, update and involve ICU professionals in nutritional care and the need for early mobilization of ICU patients.

Soluble secretory proteins with a signal peptide reach the extracellular space through the endoplasmic reticulum-Golgi conventional pathway. During translation, the signal peptide is recognised by the signal recognition particle and results in a co-translational translocation to the endoplasmic reticulum to continue the secretory pathway. However, soluble secretory proteins lacking a signal peptide are also abundant, and several unconventional (endoplasmic reticulum/Golgi independent) pathways have been proposed and some demonstrated. This work describes new features of the secretion signal called Nβ, originally identified in NaTrxh, a plant extracellular thioredoxin, that does not possess an orthodox signal peptide. We provide evidence that other proteins, including thioredoxins type h, with similar sequences are also signal peptide-lacking secretory proteins. To be a secretion signal, positions 5, 8 and 9 must contain neutral residues in plant proteins-a negative residue in position 8 is suggested in animal proteins-to maintain the Nβ motif negatively charged and a hydrophilic profile. Moreover, our results suggest that the NaTrxh translocation to the endoplasmic reticulum occurs as a post-translational event. Finally, the Nβ motif sequence at the N- or C-terminus could be a feature that may help to predict protein localisation, mainly in plant and animal proteins.

Abstract The mitochondrial genome (mtDNA) is of interest for a range of fields including evolutionary, forensic, and medical genetics. Human mitogenomes can be classified into evolutionary related haplogroups that provide ancestral information and pedigree relationships. Because of this and the advent of high-throughput sequencing (HTS) technology, there is a diversity of bioinformatic tools for haplogroup classification. We present a benchmarking of the 11 most salient tools for human mtDNA classification using empirical whole-genome (WGS) and whole-exome (WES) short-read sequencing data from 36 unrelated donors. We also assessed the best performing tool in third-generation long noisy read WGS data obtained with nanopore technology for a subset of the donors. We found that, for short-read WGS, most of the tools exhibit high accuracy for haplogroup classification irrespective of the input file used for the analysis. However, for short-read WES, Haplocheck and MixEmt were the most accurate tools. Based on the performance shown for WGS and WES, and the accompanying qualitative assessment, Haplocheck stands out as the most complete tool. For third-generation HTS data, we also showed that Haplocheck was able to accurately retrieve mtDNA haplogroups for all samples assessed, although only after following assembly-based approaches (either based on a referenced-based assembly or a hybrid de novo assembly). Taken together, our results provide guidance for researchers to select the most suitable tool to conduct the mtDNA analyses from HTS data.

We analyzed the recognition of tumor antigens by IgM in transgenic MMTV-PyVT mice. PyVT female mice are a model of breast cancer that simulates its counterpart in humans. The PyVT model allows studying antigen recognition in two conditions: before and during tumor expression. We attempted to identify by sequence, the antigens recognized by IgM that are expressed or disappear in the membrane of breast transgenic tissue during the transition “No tumor-Tumor”. 2D immunoblots were obtained of isolated membranes from the breast tissue in the fifth, sixth, and seventh week (transition point). Proteins recognized by IgM were sequenced in duplicate by MALDI-TOF. In the transition, we observed the disappearance of antigens in transgenic mice with respect to non-transgenic ones. We believe that in the diagnosis of cancer in its early stages, the expression of early antigens is as important as their early delocalization, with the latter having the advantage that, under normal conditions, we can know which proteins should be present at a given time. Therefore, we could consider that also the absence of antigens could be considered as a biomarker of cancer in progress.

Sea urchins are a group of benthic invertebrates characterized by having rigid globose bodies, covered in spines, and have an innate immune system that has allowed them to survive in the environment and defend against many pathogens that affect them. They are consumed for their unique flavor, but also for possessing a rich source of bioactive compounds which make them a source for a wide array of medicinal properties. Thus, these may be used to discover and develop new drugs such as anti-bacterials, anti-carcinogenics and anti-virals. Precisely for those reasons, this revision is centered on the known biological activities in various sea urchin species. Recently, the potential pharmacological benefits of nine sea urchin species [Diadema antillarum (Philippi 1845), Echinometra mathaei (de Blainville), Evechinus chloroticus (Valenciennes), Mesocentrotus nudus (Agassiz, 1863), Paracentrotus lividus (Lamarck, 1816), Scaphechinus mirabilis (Agazzis, 1863), Stomopneustes variolaris (Lamarck, 1816), Tripneustes depressus (Agassiz, 1863), and Tripneustes ventricosus (Lamarck, 1816)] have been evaluated. Our work includes a comprehensive review of the anti-fungal, anti-parasitic, anti-inflammatory, hepatoprotective, anti-viral, anti-diabetic, anti-lipidemic, gastro-protective and anti-cardiotoxic effects. Furthermore, we revised the compounds responsible of these pharmacological effects. This work was intended for a broad readership in the fields of pharmacology, drugs and devices, marine biology and aquaculture, fisheries and fish science. Our results suggest that organic extracts, as well as pure compounds obtained from several parts of sea urchin bodies are effective in vitro and in vivo pharmacological models. As such, these properties manifest the potential use of sea urchins to develop emergent active ingredients.

Background: elderly are vulnerable of suffering from depressive symptoms. Its early detection and timely treatment is important. One of the most widely used instruments in the medical literature for the evaluation of depressive symptoms is the Zung and Conde self-scale. Objective: to determine the diagnostic capacity of the Zung and Conde self-scale for depressive symptoms in a Cuban geriatric population. Methods: from the quantitative approach, a descriptive study was carried out, with a cross-sectional design, between May 2019 and March 2020. The universe was made up of 12,223 elderly people from the Holguín municipality. 100 elderly were selected through probability sampling. Socio-demographic variables, cognitive functioning, depressive symptoms, and diagnostic capacity for depressive symptoms of the Zung and Conde self-scale were considered as variables. The semi-structured interview, the Zung and Conde depression self-scale, the Folstein Mini-Examination of Mental State (M.M.S.E), the Katz index and the Lawton scale were used. The results were processed in the EPIDAT 3.1 and MedCalc statistical packages. Results: in general, the instrument showed moderate sensitivity and specificity for the diagnosis of depressive symptoms. The cut-off point with the largest area under the curve was ≥41. Conclusions: the Zung and Conde depression self-scale showed a good diagnostic capacity for the possible suffering of depressive symptoms in the Cuban geriatric population. The cut-off point for a better sensitivity-specificity relationship was from 41. DeCS: AGED; PATIENT HEALTH QUESTIONNAIRE; DEPRESSION/diagnosis; DEPRESSION/classification; EPIDEMIOLOGY, DESCRIPTIVE.

CASE PRESENTATION Prosthetic valve thrombosis (PVT) is a complication associated with a high morbimortality rate. Yet despite anticoagulation, the rate of PVT is between 0.5% and 8%.1 The management of this disease depends on various factors like the size and location of the thrombus, the degree of valvular obstruction or dysfunction, the symptoms at presentation, and the patient’s hemodynamic status. Therapeutic options include surgery and fibrinolysis. Both have given good results, but they are not always effective and are associated with a high risk of complications. This is the case of a 55-year-old woman with rheumatic myocardiopathy treated with aortic and mitral valve replacement using the bidisco ATS 27 mechanical heart valve (Medtronic ATS Medical, Inc, Plymouth, Minnesota, United States) and Sorin Overline 29 device (Sorin Biomedica Cardio SpA, Saluggia, Italy), respectively. The patient granted consent to publish her case, respecting her right to privacy and the protection of personal data. Two months after surgery the patient was showing signs of dyspnea (New York Heart Association functional class III) and she was diagnosed with obstructive thrombosis of the prosthetic mitral valve. The transesophageal echocardiography (TEE) performed revealed the presence of a mass compatible with a thrombus attached to the atrial side of...

A cysticercosis model of Taenia crassiceps ORF strain in susceptible BALB/c mice revealed a Th2 response after 4 weeks, allowing for the growth of the parasite, whereas resistant C57BL/6 mice developed a sustained Th1 response, limiting parasitic growth. However, little is known about how cysticerci respond to an immunological environment in resistant mice. Here, we show that the Th1 response, during infection in resistant C57BL/6 mice, lasted up to 8 weeks and kept parasitemia low. Proteomics analysis of parasites during this Th1 environment showed an average of 128 expressed proteins; we chose 15 proteins whose differential expression varied between 70 and 100%. A total of 11 proteins were identified that formed a group whose expression increased at 4 weeks and decreased at 8 weeks, and another group with proteins whose expression was high at 2 weeks and decreased at 8 weeks. These identified proteins participate in tissue repair, immunoregulation and parasite establishment. This suggests that T. crassiceps cysticerci in mice resistant under the Th1 environment express proteins that control damage and help to establish a parasite in the host. These proteins could be targets for drugs or vaccine development.

There is a lack of region-adapted tools to evaluate diet as a risk factor for cardiovascular disease (CVD) in adolescents. The study aim was to evaluate the reproducibility and validity of a paper-based and region-adapted food frequency questionnaire (FFQ) designed to assess CVD-related food and nutrient intakes of adolescents from Northwest México. The study design was cross-sectional. The FFQ was developed in a two-step process: prototype designing and a pilot test, with re-tested in a 3-month period, along with two administrations of 24 h-recall (24 hR). Pearson's and intra-class correlation coefficients (PCC and ICC) were assessed. Bland–Altman plots, limits of agreement and quintile classifications were carried out. Participants (n 221) were 53·8 % male, 18·5 ± 0·4 years old. Reproducibility had a median PCC = 0·66 for processed meats, ranging from 0·40 (saturated fat) to 0·74 (fish & shellfish), P = 0·001. ICC ranged from 0·53 (saturated fat) to 0·80 (sodium; and nuts, seeds and legumes), P = 0·001. Validity comparing FFQ1 v. 24 hR mean, PCCs ranged from 0·12 (P = 0·06) to 0·95 (P = 0·001), and ICC from 0·20 (P = 0·048) to 0·88 (P = 0·001); comparing FFQ2 v. 24 hR mean, PCCs ranged from 0·07 (P = 0·25) to 0·46 (P = 0·001), and ICC from 0·15 (P = 0·106) to 0·58 (P = 0·001). The FFQ overestimated the intake of all food groups and nutrients (P < 0·05), while Cohen's κ showed coefficients lower than 0·20. The proposed FFQ represents a moderately validated tool to estimate CVD-related food and nutrient intakes as a risk factor, which can be used in combination with multiple administrations of 24 hRs, as a critical mean in future interventions intended to reduce cardiometabolic risk in adolescents.

Background Pseudalcantarea grandis (Schltdl.) Pinzón & Barfuss is a tank bromeliad that grows on cliffs in the southernmost portion of the Chihuahuan desert. Phytotelmata are water bodies formed by plants that function as micro-ecosystems where bacteria, algae, protists, insects, fungi, and some vertebrates can develop. We hypothesized that the bacterial diversity contained in the phytotelma formed in a bromeliad from an arid zone would differ in sites with and without surrounding vegetation. Our study aimed to characterize the bacterial composition and putative metabolic functions in P. grandis phytotelmata collected in vegetated and non-vegetated sites. Methods Water from 10 individuals was sampled. Five individuals had abundant surrounding vegetation, and five had little or no vegetation. We extracted DNA and amplified seven hypervariable regions of the 16S gene (V2, V4, V8, V3–6, 7–9). Metabarcoding sequencing was performed on the Ion Torrent PGM platform. Taxonomic identity was assigned by the binning reads and coverage between hit and query from the reference database of at least 90%. Putative metabolic functions of the bacterial families were assigned mainly using the FAPROTAX database. The dominance patterns in each site were visualized with rank/abundance curves using the number of Operational Taxonomic Units (OTUs) per family. A percentage similarity analysis (SIMPER) was used to estimate dissimilarity between the sites. Relationships among bacterial families (identified by the dominance analysis and SIMPER), sites, and their respective putative functions were analyzed with shade plots. Results A total of 1.5 million useful bacterial sequences were obtained. Sequences were clustered into OTUs, and taxonomic assignment was conducted using BLAST in the Greengenes databases. Bacterial diversity was 23 phyla, 52 classes, 98 orders, 218 families, and 297 genera. Proteobacteria (37%), Actinobacteria (19%), and Firmicutes (15%) comprised the highest percentage (71%). There was a 68.3% similarity between the two sites at family level, with 149 families shared. Aerobic chemoheterotrophy and fermentation were the main metabolic functions in both sites, followed by ureolysis, nitrate reduction, aromatic compound degradation, and nitrogen fixation. The dominant bacteria shared most of the metabolic functions between sites. Some functions were recorded for one site only and were related to families with the lowest OTUs richness. Bacterial diversity in the P. grandis tanks included dominant phyla and families present at low percentage that could be considered part of a rare biosphere. A rare biosphere can form genetic reservoirs, the local abundance of which depends on external abiotic and biotic factors, while their interactions could favor micro-ecosystem resilience and resistance.

Goat production in Mexico is an important economic activity that is affected by different gastrointestinal nematode (GIN) species. GINs resistant to commercial anthelmintics have been reported. Plant extracts or agro-industrial by-products, such as coffee pulp, have been proposed as control alternatives, given their secondary metabolite content. The aim of the present study was to determine the anthelmintic activity of the hydroalcoholic extract of coffee pulp against benzimidazole-resistant GINs. Stool samples were collected from goats, from which GIN eggs were identified and quantified. Molecular techniques confirmed the genus of GINs and their benzimidazole resistance profile. The percentage of egg hatching inhibition (% EHI) and larval mortality (% LM) with the hydroalcoholic extract of coffee pulp was determined at concentrations from 200 to 0.39 mg/mL. The genera Haemonchus spp. and Trichostrongylus spp. were identified, and the presence of the β-tubulin gene mutation, associated with benzimidazole (BZ) resistance, was determined. Hydroalcoholic extract of coffee pulp inhibited 100% of egg hatching at 200 and 100 mg/mL, with no larvicidal effect at the evaluated concentrations.

Introduction Reduction of milk protein content in infant formula provided during the first year of life has been shown to reduce early weight gain and obesity later in life. While rapid weight gain during the first 2 years of life is one of the strongest early predictors of obesity, the role of animal protein intake beyond the first year of life is unclear. The aim of this study is to examine the role of milk protein during the second year of life in healthy children on weight gain and obesity risk in preschool age.Methods and analysis This randomised, double-blinded study enrolled 1618 children aged 11.5–13.5 months in Spain and Germany into two groups receiving isocaloric toddler milk with differing protein content during the second year of life. The experimental formula contains 1.5 g/100 kcal and the control formula 6.15 g/100 kcal protein and otherwise equal formula composition, except for modified fat content to achieve equal energy density. The primary endpoint is body mass index (BMI)-for-age z-score at the age of 24 months adjusted for BMI at 12 months of age. The children are followed until 6 years of age.Ethics and dissemination Ethics approval was obtained from the ethical committees of the LMU University Hospital Munich, Germany (Nr. 555-15) and at Institut d’Investigació Sanitaria Pere Virgili, Reus, Spain (Ref. CEIm IISPV 013/2016). We aim at publishing results in peer-reviewed journals and sharing of results with study participants.Trial registration number NCT02907502.

Abstract Here we studied HLA blocks and haplotypes in a group of 218 Lacandon Maya Native American using a high-resolution next generation sequencing (NGS) method. We assessed the genetic diversity of HLA class I and class II in this population, and determined the most probable ancestry of Lacandon Maya HLA class I and class II haplotypes. Importantly, this Native American group showed a high degree of both HLA homozygosity and linkage disequilibrium across the HLA region and also lower class II HLA allelic diversity than most previously reported populations (including other Native American groups). Distinctive alleles present in the Lacandon population include HLA-A*24:14 and HLA-B*40:08. Furthermore, in Lacandons we observed a high frequency of haplotypes containing the allele HLA-DRB1*04:11, a relatively frequent allele in comparison with other neighboring indigenous groups. The specific demographic history of the Lacandon population including inbreeding, as well as pathogen selection, may have elevated the frequencies of a small number of HLA class II alleles and DNA blocks. To assess the possible role of different selective pressures in determining Native American HLA diversity, we evaluated the relationship between genetic diversity at HLA-A, HLA-B and HLA-DRB1 and pathogen richness for a global dataset and for Native American populations alone. In keeping with previous studies of such relationships we included distance from Africa as a covariate. After correction for multiple comparisons we did not find any significant relationship between pathogen diversity and HLA genetic diversity (as measured by polymorphism information content) in either our global dataset or the Native American subset of the dataset. We found the expected negative relationship between genetic diversity and distance from Africa in the global dataset, but no relationship between HLA genetic diversity and distance from Africa when Native American populations were considered alone.

Abstract Malignant transformation and progression in cancer is associated with the altered expression of multiple miRNAs, which are considered as post-transcriptional regulators of genes participating in various cellular processes. Although, it has been proposed that miR-23b-3p acts as a tumor suppressor in cervical cancer (CC), not all the pathways through which it alters the cellular processes have been described. The present study examines whether miR-23b-3p directly represses the c-Met expression and that consequently modifies the proliferation, migration and invasion of C33A and CaSki cells. c-Met has five microRNA response elements (MREs) for miR-23b-3p in the 3′-UTR region. The ectopic overexpression of miR-23b-3p significantly reduces c-Met expression in C33A and CaSki cells. The overexpression of miR-23b-3p reduces proliferation, migration and invasion of CaSki cells and the proliferation and invasion in C33A cells. In CaSki cells, the activation of Gab1 and Fak, downstream of c-Met, is reduced in response to the overexpression of miR-23b-3p. Together, the results in the present study indicate that miR-23b-3p is a tumor suppressor that modulates the progression of CC via post-transcriptional regulation of the c-Met oncogene.

Abstract Despite many cardioprotective interventions have shown to protect the heart against ischemia/reperfusion injury in the experimental setting, only few of them have succeeded in translating their findings into positive proof-of-concept clinical trials. Controversial and inconsistent experimental and clinical evidence supports the urgency of a disruptive paradigm shift for testing cardioprotective therapies. There is a need to evaluate experimental reproducibility before stepping into the clinical arena. The CIBERCV (acronym for Spanish network-center for cardiovascular biomedical research) has set up the “Cardioprotection Large Animal Platform” (CIBER-CLAP) to perform experimental studies testing the efficacy and reproducibility of promising cardioprotective interventions based on a pre-specified design and protocols, randomization, blinding assessment and other robust methodological features. Our first randomized, control-group, open-label blinded endpoint experimental trial assessing local ischemic preconditioning (IPC) in a pig model of acute myocardial infarction (n = 87) will be carried out in three separate sets of experiments performed in parallel by three laboratories. Each set aims to assess: (A) CMR-based outcomes; (B) histopathological-based outcomes; and (C) protein-based outcomes. Three core labs will assess outcomes in a blinded fashion (CMR imaging, histopathology and proteomics) and 2 methodological core labs will conduct the randomization and statistical analysis.

ABSTRACT Introduction and objectives: Regadenoson, a selective agonist of the A2a receptors of adenosine, has been proposed as an alternative for the measurement of fractional flow reserve (FFR). The goal of our study was to assess the utility of regadenoson compared to the use of intracoronary adenosine. Methods: Forty-one intermediate coronary lesions (30%-70%), in which functional assessment with pressure wire was indicated, were included both prospective and consecutively. Each patient was sequentially administered intracoronary adenosine and intravenous regadenoson and hemodynamic data while the adverse effects were recorded with hyperemia induced by both drugs. The differences seen in the final FFR were analyzed using the linear regression model and the clinically relevant discrepancies were identified assuming 0.80 as the cut-off point. Results: The mean of the FFR was significantly lower with regadenoson compared to adenosine (0.838 ± 0.072 vs 0.852 ± 0.073, P = .002) and in 4 cases (9.8%) clinically relevant differences were found. The regression analysis showed a strong linear correlation between the individual values (r = 0.925, P < .001). Both adenosine and regadenoson significantly reduced mean arterial blood pressure and only regadenoson significantly increased baseline heart rate. In 2 cases (4.9%) asystole was recorded > 3 seconds after the administration of adenosine and no complications were observed with regadenoson. Conclusions: The administration of regadenoson through an intravenous single bolus has shown a significant reduction in the value of FFR compared to the administration of intracoronary adenosine boluses and the observed differences may be relevant in the clinical decision-making process.

Chagas disease (CD), caused by the protozoan Trypanosoma cruzi, is an important problem of public health even in regions where it is not endemic. Spain ranks second worldwide in terms of imported cases of T. cruzi infection in the chronic phase. The diagnosis in this stage is made via the detection of antibodies against T. cruzi. Therefore, we aimed to evaluate the sensitivity and specificity of two fully automated chemiluminescence immunoassays, Chagas VirClia® (CHR), which uses a mixture of recombinant antigens, and Chagas TESA VirClia® (TESA), the first chemiluminescence assay based on excretion-secretion antigens of trypomastigotes, both designed in monotest format. A retrospective case–control study was performed using 105 well-characterized samples: 49 from patients with CD, 22 from uninfected individuals, and 32 from patients with other pathologies. Sensitivity was 98% for CHR and 92% for TESA. In contrast, the specificity in both was 100%. Cross-reactivity was observed in leishmaniasis (2/10). CHR meets the criteria to become a tool for serological screening, while TESA has the potential for confirmation and cross-reaction discrimination. The monotest format allows its application in laboratories with a small number of samples. The high specificity of both assays is useful in areas where leishmaniasis is endemic.

Background Uropathogenic Escherichia coli (UPEC) is the causative agent of uncomplicated urinary tract infections (UTIs) in ambulatory patients. However, enteroaggregative E. coli (EAEC), an emergent bacterial pathogen that causes persistent diarrhoea, has recently been associated with UTIs. The aim of this study was to determine the frequency of EAEC virulence genes, antibiotic resistance, as well as biofilm production of UPEC isolates obtained from ambulatory patients with non-complicated UTIs that attended to the ISSSTE clinic in Chilpancingo, Guerrero, Mexico, and correlate these with the patients’ urinary tract infection symptomatology. Methods One hundred clinical isolates were obtained. The identification of clinical isolates, antimicrobial susceptibility testing, and extended spectrum beta-lactamases (ESBLs) production were performed using the Vitek automated system. Assignment of E. coli phylogenetic groups was performed using the quadruplex phylo-group assignment PCR assay. UPEC virulence genes (hlyA, fimH, papC, iutA, and cnf1) and EAEC virulence genes (aap, aggR, and aatA) were detected by multiple PCR. Results We found that 22% of the isolates carried the aggR gene and were classified as UPEC/EAEC. The main phylogenetic group was B2 (44.1% were UPEC and 77.27% UPEC/EAEC isolates, respectively). Over half of the UPEC/EAEC isolates (63.64%) were obtained from symptomatic patients, however the aatA gene was the only one found to be associated with the risk of developing pyelonephritis (OR = 5.15, p = 0.038). A total of 77.71% of the UPEC/EAEC isolates were ESBL producers and 90.91% multidrug-resistant (MDR). In conclusion, UPEC/EAEC isolates are more frequent in symptomatic patients and the aatA gene was associated with a higher risk of developing pyelonephritis, along with UPEC genes hlyA and cfn1. UPEC/EAEC isolates obtained from UTI showed ESBL production and MDR.

Objectives: Dilation and curettage is an outdated abortion procedure no longer recommended by the World Health Organization. However, use of dilation and curettage remains high in some countries, including Mexico. We aim to understand the factors that contribute to persistent use of dilation and curettage in Mexico. Methods: We conducted a mixed-methods study in two phases: (1) secondary quantitative data analysis from 40 Ipas-supported public hospitals in Mexico and (2) 28 in-depth interviews in 9 Ipas-affiliated hospitals with doctors, nurses, and hospital administrators. Results: Among our sample, 41% of abortions less than 13 weeks performed in 2019 were treated with dilation and curettage, while this increased to 67% of abortions at or above 13 weeks. Only 18% of induced abortions were performed with dilation and curettage compared to 44% of post-abortion care procedures. The main factor identified as determining use of dilation and curettage in in-depth interviews was availability of abortion supplies, both in terms of cleaning, storage, and maintenance of supplies and in the budgeting and procurement of supplies. Other factors included confidence in the efficacy of other methods, attitudes toward different methods, skill and training, and perceived benefits to patients. Conclusion: Ensuring supplies for recommended abortion methods are available is a key lever for any intervention aimed at reducing dilation and curettage use. However, as the doctor performing the abortion decides which method to use, individual factors such as lack of skill and mistrust in other procedures can become a particularly obstinate barrier to recommended method use. Localizing decision-making power in the hands of doctors is problematic in that it places the doctor’s preference above that of the person receiving the abortion. It is important to look deeply at the power structures that contribute to doctor-oriented models of abortion care.

American Criollo pigs are thought to descend mainly from those imported from the Iberian Peninsula starting in the late 15th century. Criollo pigs subsequently expanded throughout the Americas, adapting to very diverse environments, and possibly receiving influences from other origins. With the intensification of agriculture in the mid-20th century, cosmopolitan breeds largely replaced Criollo pigs, and the few remaining are mostly maintained by rural communities in marginal areas where they still play an important socio-economic and cultural role. In this study, we used 24 microsatellite markers in samples from 1715 pigs representing 46 breeds with worldwide distribution, including 17 American Criollo breeds, with the major focus of investigating their genetic diversity, structure and breed relationships. We also included representatives of the Iberian, Local British, Hungarian, Chinese and Commercial breeds, as well as Wild Boar, in order to investigate their possible influence in the genetic composition of Criollos. Our results show that, when compared with the other breeds, Criollo pigs present higher levels of genetic diversity, both in terms of allelic diversity and expected heterozygosity. The various analyses indicate that breed differentiation overall explains nearly 21% of the total genetic diversity. Criollo breeds showed their own identity and shared a common genetic background, tending to cluster together in various analyses, even though they differ from each other. A close relationship of Criollos with Iberian breeds was revealed by all the different analyses, and the contribution of Iberian breeds, particularly of the Celtic breeds, is still present in various Criollo breeds. No influence of Chinese breeds was detected on Criollos, but a few were influenced by Commercial breeds or by wild pigs. Our results confirm the uniqueness of American Criollo pigs and the role that Iberian breeds have played in their development.

BackgroundAcute kidney injury (AKI) is associated with poor outcomes in COVID patients. Differences between hospital-acquired (HA-AKI) and community-acquired AKI (CA-AKI) are not well established.MethodsProspective, observational cohort study. We included 877 patients hospitalized with COVID diagnosis at two third-level hospitals in Mexico. Primary outcome was all-cause mortality at 28 days compared between COVID patients with CA-AKI and HA-AKI. Secondary outcomes included the need for KRT, and risk factors associated with the development of CA-AKI and HA-AKI.ResultsA total of 377 patients (33.7%) developed AKI. CA-AKI occurred in 202 patients (59.9%) and HA-AKI occurred in 135 (40.1%). Patients with CA-AKI had more significant comorbidities, including diabetes (52.4% vs 38.5%), hypertension (58.4% vs 39.2%), CKD (30.1% vs 14.8%), and COPD (5.9% vs 1.4%), than those with HA-AKI. Patients' survival without AKI was 87.1%, with CA-AKI it was 75.4%, and with HA-AKI it was 69.6%, log-rank test p < 0.001. Only age > 60 years (OR 1.12, 95% CI 1.06-1.18, p ConclusionsWe found that COVID patients who are complicated by CA-AKI have more comorbidities and worse biochemical parameters at the time of hospitalization than HA-AKI patients, but despite these differences, their probability of dying is similar.

Peach tree allergens are present in fruit, pollen, branches, and leaves, and can induce systemic, respiratory, cutaneous, and gastrointestinal symptoms. We studied the capacity of peach fruit/Pru p 1, Pru p 3, Pru p 4, Pru p 7 and peach pollen/Pru p 9 for inducing symptoms following oral or respiratory exposure in a large group of subjects. We included 716 adults (aged 21 to 83 y.o.) exposed to peach tree pollen and fruit intake in the study population. Participants completed a questionnaire and were skin tested with a panel of inhalant and food allergens, including peach tree pollen, Pru p 9 and peach fruit skin extract. Immunoglobulin E antibodies (SIgE) to Pru p 1, Pru p 3, Pru p 4 and Pru p 7 were quantified. Sensitised subjects underwent oral food challenge with peach fruit and nasal provocation test with peach tree pollen and Pru p 9. The prevalence of sensitisation to peach fruit was 5% and most of these had SIgE to Pru p 3, with a very low proportion to Pru p 4 SIgE and no SIgE to Pru p 1 and Pru p 7. In only 1.8%, anaphylaxis was the clinical entity induced. Cases with positive skin tests to peach and SIgE to Pru p 3 presented a good tolerance after oral challenge with peach fruit. The prevalence of skin sensitisation to peach tree pollen was 22%, with almost half recognising Pru p 9. This induced respiratory symptoms in those evaluated by nasal provocation. In a large population group exposed to peach fruit and peach tree pollen, most individuals were tolerant, even in those with SIgE to Pru p 3. A positive response to Pru p 9 was associated with respiratory allergy.

Background: there is a high incidence of cases with renal carcinoma in Las Tunas. Its curative treatment is surgery with exeresis of the tumor or of the affected kidney.Objective: to characterize clinical and epidemiological variables of patients with renal cell carcinoma treated with radical nephrectomy at the department of urology of the “Dr. Ernesto Guevara de la Serna” General Teaching Hospital of Las Tunas, from January 2016 to December 2018.Methods: a cross-sectional descriptive study was carried out at the aforementioned institution and during the period herein declared. The study population was made up of the 67 patients between 30 and 80 years of age, with a diagnosis of renal cell carcinoma and treated with radical nephrectomy.Results: there was a predominance of male patients, 64,2 %, of the 51 to 60 age group, 50,7 % and of white skin, 58,2 %. Smoking was present in 41,7 % of the studied cases. 37,3 % and 34,3 % presented lumbar pain and hematuria, respectively. In 58,2 % of the cases the right kidney was the most affected one. The main complications were intense pain, present in 80 %, hemorrhage in 46,5 % and infection in the surgical wound in 23,4 %. There was a prevalence of the anterior way in open-sky surgical technique, in 68 %.Conclusions: the variables in patients with renal cell adenocarcinoma treated with radical nephrectomy were characterized.

Massive accumulations of pelagic species of Sargassum have generated recent social, economic and ecological problems along Caribbean shores. In the Mexican Caribbean, these events have prompted the study of diverse biological and ecological aspects of these macroalgae. However, studies on their associated biota, including Hydrozoa, remain scarce. This research provides important species observations in an area where data is lacking. The occurrence and percent cover of hydroids on Sargassum thalli collected on the beach at Puerto Morelos, Quintana Roo, Mexico from April 2018 to March 2019 was studied. Three pelagic species and morphotypes of Sargassum from this area were analyzed: Sargassum fluitans III, S. natans I and S. natans VIII, as well as a benthic species, S. polyceratium var. ovatum. A total of 14 taxa of hydroids, belonging to the superorders “Anthoathecata” and Leptothecata, were identified. In our study, more hydroid taxa were observed on axes of the different species of Sargassum than on leaves or aerocysts. In general, the greatest species richness of hydroids was observed from February to April. Results show that live hydrozoans attached to pelagic Sargassum are transported into the area. This should be considered in future management measures that address the recurring coastal abundance of Sargassum and its associated biota in the Caribbean region.

To the Editor, Currently, transradial approach is the most widely used access route both in coronary angiographies and percutaneous coronary interventions.1 However, it is not rare to find anatomical difficulties like severe spasm, small-caliber vessel, loops or tortuosities that cannot be overcome with the usual techniques and lead to access route changes eventually.2 In these situations, the advance of the catheter can dissect or perforate the artery and cause hematomas or even compartmental syndrome, although this entity is rare.3 As the main cause of resistance when advancing the catheter, Patel et al.4 identified the so-called razor effect exerted by the catheter distal border on the vessel wall (figure 1A), a mechanism that has been confirmed in optical coherence tomography studies.5 These same authors described the balloon-assisted tracking (BAT) technique4 that consists of inflating an angioplasty balloon that partially protrudes across the catheter distal border to keep its coaxial position with the artery avoiding the razor effect and providing better maneuverability (figure 1B). Therefore, the anatomical difficulty is crossed using a 0.014 in soft tip angioplasty guidewire. Afterwards, a 1.5 mm to 2.0 mm semicompliant balloon is inflated between 6 and 8 atm at the tip of the catheter and advanced en bloc...

Abstract Host diet is a major determinant of the composition and function of the intestinal microbiome. Less understood is the importance of diet on ingested strains with probiotic significance. We investigated the population dynamics of exogenous Lactobacillus plantarum and its interactions with intestinal bacteria in mice undergoing switches between high-fat, high-sugar (HFHSD) and low-fat, plant-polysaccharide rich (LFPPD) diets. The survival and persistence of ingested L. plantarum WCFS1 was significantly improved during mouse consumption of HFHSD and was negatively associated with the numbers of indigenous Lactobacillus species. Diet also rapidly changed the composition of the indigenous microbiota, but with some taxa differentially affected between HFHSD periods. L. plantarum was not integrated into indigenous bacterial community networks according to co-occurrence patterns but still conferred distinct effects on bacterial species diversity and microbiota stability largely in a diet-dependent manner. Metagenome predictions supported the premise that L. plantarum dampens the effects of diet on the microbiome. This strain also consistently altered the predicted genetic content in the distal gut by enriching for genes encoding glyosyltransferases and bile salt hydrolases. Our findings demonstrate the interactions between ingested, transient probiotic bacteria and intestinal bacterial communities and how they can differ depending on host diet.

BackgroundDuring their workday, nurses face a variety of stressors that are dealt with using different coping strategies. One criticism of the contextual models of work stress is that they fail to focus on individual responses like coping with stress. Neverthless, little is know about the momentary determinants of coping in nurses.ObjectivesTo identify the momentary predictors of problem-focused approaching coping and emotion-focused approaching coping, as well as those for seeking social support and refusal coping strategies, during the working day in nurses.DesignThis study uses descriptive, correlational, two-level design with repeated measures.SettingsWards of two University hospitals.ParticipantsA random cohort of 113 nurses was studied.MethodsAn ecological momentary assessment was made of demand, control, effort, reward, nursing task, coping, mood and fatigue, and of coping style by questionnaire. Multilevel two-level statistical analyses were performed in order to identify both within person and between person relationships.ResultsDifferent momentary types of coping were associated with different tasks. The problem-focused coping could be explained by the direct care and medication tasks, demand, planning coping style, mood, and negatively by acceptation coping style. Emotion-focused coping could be explained by documentation and medication tasks (negatively), mood, demand, distraction, and disengagement coping styles. Seeking social support coping could be explained by the task of communication, mood, fatigue (negatively), and seeking emotional support as a coping style. Refusal coping could be explained by mood, and the coping style of focusing and venting emotions. Refusal coping is not specific to any task.ConclusionsThe choice of the coping strategy depends on the task, of their appraisal and on the different styles of coping.

Introduction Chronic pain has become a matter of public health concern due to its high prevalence and because public costs associated with treatment and disability increase each year. Research suggests that limitations in the traditional assessment of chronic pain patients limit the effectiveness of current medical treatments. The use of technology might serve change patient traditional monitoring into ecological momentary assessments, which might be visualised by physicians live. This study describes a randomised control trial designed to test the utility of a technology-based solution for pain telemonitoring consisting of a smartphone app for patients and a web application for physicians. The goal of this study will be to explore whether this combination of eHealth and mHealth improves the effectiveness of existing pain treatments.Methods and analysis Participants will be 250 patients randomly assigned to one of these two conditions: treatment-as-usual (TAU) and TAU +app+ web. All participants will receive the usual treatment for their pain. Only the TAU +app+ web group use Pain Monitor app, which generates alarms that are sent to the physicians in the face of previously established undesired events. Physicians will be able to monitor app reports using a web application, which might result in an adjustment of treatment. We anticipate that the use of Pain Monitor plus the therapist web will result in a reduction of pain intensity and side effects of the medication. Improvements on secondary outcomes, namely fatigue, mood, pain interference, rescue medication use and quality of life, are also expected. Mixed repeated-measure multivariate analyses of variances will be conducted to investigate whether there are differences between preassessment and postassessment scores as a function of the experimental condition.Ethics and dissemination Ethical approval from the Hospital General Universitari de Castellon was obtained. The findings will be published in peer-reviewed journals.Trial registration number NCT03606265

Ketoprofen is a commercially available drug sold as a racemic mixture that belongs to the family of non-steroidal anti-inflammatory drugs known as profens. It has been demonstrated (in vitro) that (S)-ketoprofen is around 160 times more potent than its enantiomer (R)-ketoprofen, while accumulation of (R)-ketoprofen can cause serious side effects, such as dyspepsia, gastrointestinal ulceration/bleeding, pain, salt and fluid retention, and hypertension. In this work, four commercially available lipases were systematically assessed. Parameters such as conversion, enantiomeric excess, and enantioselectivity were considered. Among them, and by evaluating lipase load, temperature, solvent, and alcohol, Candida rugosa lipase exhibited the best results in terms of enantioselectivity E = 185 ((S)-enantiopreference) with esterification conversions of c = 47% (out of 50%) and enantiomeric excess of 99%. The unreacted (R)-enantiomer was recovered by liquid-liquid extraction and racemized under basic media, which was recycled as starting material. Finally, the (S)-alkyl ketoprofen ester was successfully enzymatically hydrolyzed to the desired (S)-ketoprofen with c = 98.5% and 99% ee. This work demonstrated the benefit and efficiency of using Candida rugosa lipase to kinetically resolve racemic ketoprofen by an environmentally friendly protocol and with the recycling of the undesired (R)-ketoprofen.

Background: The reemergence of measles represents a public health problem. The aim of the study was to determine the seroprevalence of IgG antibodies against measles in children of three ethnic groups in southern Mexico and the nutritional status and demographic risk factors associated. Methods: A cross-sectional study in 416 school-age children, 207 belonging to the Tlapaneco ethnic group, 101 to the Mixteco group and 108 were considered Mestizo. Sociodemographic data were collected, an anthropometric evaluation of the children was performed and a fasting blood sample was obtained from each child for the measurement of measles IgG antibodies by Enzyme-Linked Immunosorbent Assay (ELISA). Results: From the total sample, 59% of the children were seropositive for IgG antibodies against measles; in contrast, 41% lacked IgG antibodies. Measles antibody seropositivity was higher in girls (64%). 90.5% of 6-year-old children had higher antibodies seroprevalence, compared to the children between 10 and 13 years old (45.5%). In the three ethnic groups, age was negatively correlated with the index standard ratio (ISR) of measles antibody levels and the families with ≥8 members showed less seropositivity. According to the antibodies levels, most of the positive cases remained around 1 Standard Deviation (SD) of the ISR values and no underweight children had antibody levels above 2 SD. Conclusions: The Anti-Measles serological coverage is low in children of three ethnic groups from Southern Mexico and the age, sex, malnutrition and family size are associated factors. Therefore, it is important to strengthen immunization campaigns, principally in vulnerable groups.