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Abstract The phase angle is a versatile measurement to assess body composition, frailty and prognosis in patients with chronic diseases. In cirrhosis, patients often present alterations in body composition that are related to adverse outcomes. The phase angle could be useful to evaluate prognosis in these patients, but data are scarce. The aim was to analyse the prognostic value of the phase angle to predict clinically relevant events such as hospitalisation, falls, and mortality in patients with cirrhosis. Outpatients with cirrhosis were consecutively included and the phase angle was determined by electrical bioimpedance. Patients were prospectively followed to determine the incidence of hospitalisations, falls, and mortality. One hundred patients were included. Patients with phase angle ≤ 4.6° (n = 31) showed a higher probability of hospitalisation (35% vs 11%, p = 0.003), falls (41% vs 11%, p = 0.001) and mortality (26% vs 3%, p = 0.001) at 2-year follow-up than patients with PA > 4.6° (n = 69). In the multivariable analysis, the phase angle and MELD-Na were independent predictive factors of hospitalisation and mortality. Phase angle was the only predictive factor for falls. In conclusion, the phase angle showed to be a predictive marker for hospitalisation, falls, and mortality in outpatients with cirrhosis.

Cilia, tiny outgrowths of cells, are essential for life. Here, the author’s describe the scaffold protein TRIP6, which promotes the assembly of ciliary proteins required for ciliogenesis, and show that its absence results in hydrocephalus.

We use a formulation of Noether’s theorem for contact Hamiltonian systems to derive a relation between the thermodynamic entropy and the Noether invariant associated with time-translational symmetry. In the particular case of thermostatted systems at equilibrium, we show that the total entropy of the system plus the reservoir are conserved as a consequence thereof. Our results contribute to understanding thermodynamic entropy from a geometric point of view.

Sustainable production of lignocellulosic biomass for energy use can contribute to climate change mitigation. This work aims to compare the biomass production of twelve fast-growing woody taxa belonging to the Eucalyptus, Casuarina, Populus and Paulownia genera, the quality of their biomass for energy use and its valorizing through transformation into pellets, as well as the effect of the crop on the soil. Over the course of two rotations, plant growth and biomass production were assessed. The yield of aboveground dry biomass ranged from 9 to 61 Mg ha−1 year−1 (equivalent to 137–867 GJ ha−1 year−1). The highest yields were obtained for Eucalyptus clones (51–61 Mg ha−1 year−1). The N-fixing species Casuarina equisetifolia and two Populus × euramericana clones (‘Adige’ and ‘AF2’) also achieved high yields (28–33 Mg ha−1 year−1), though significantly smaller than those of the eucalypts. Due to its low wood density, Paulownia fortunei was not very productive in terms of biomass (18 Mg ha−1 year−1), despite its good growth in diameter and height. However, some management practices, such as not removing nutrient-rich and poor-quality biomass fractions for energy use (leaves and thin branches) from the harvested crop, as well as the use of N-fixing species and by taking into account all nutrient inputs and outputs, can ensure the sustainability of the cultivation systems and improve degraded soils.

The use of biopolymeric materials is restricted for some applications due to their deficient properties in comparison to synthetic polymers. Blending different biopolymers is an alternative approach to overcome these limitations. In this study, we developed new biopolymeric blend materials based on the entire biomasses of water kefir grains and yeast. Film-forming dispersions with varying ratios of water kefir to yeast (100/0, 75/25, 50/50 25/75 and 0/100) underwent ultrasonic homogenisation and thermal treatment, resulting in homogeneous dispersions with pseudoplastic behaviour and interaction between both biomasses. Films obtained by casting had a continuous microstructure without cracks or phase separation. Infrared spectroscopy revealed the interaction between the blend components, leading to a homogeneous matrix. As the water kefir content in the film increased, transparency, thermal stability, glass transition temperature and elongation at break also increased. The thermogravimetric analyses and the mechanical tests showed that the combination of water kefir and yeast biomasses resulted in stronger interpolymeric interactions compared to single biomass films. The ratio of the components did not drastically alter hydration and water transport. Our results revealed that blending water kefir grains and yeast biomasses enhanced thermal and mechanical properties. These studies provided evidence that the developed materials are suitable candidates for food packaging applications.

The coffee berry borer (CBB), Hypothenemus hampei (Ferrari, 1867) (Coleoptera: Curculionidae: Scolytinae), is the pest that causes the most economic damage to coffee crops. Chemical control of this insect is based on the use of insecticides that can affect the environment and nontarget organisms. Despite the fact that caffeine has shown potential as an insecticide, a caffeine-based product for field use is currently not available on the market. As a new alternative to control CBB and other coffee pests, such as Monalonion velezangeli Carvalho and Costa, 1988 (Hemiptera: Miridae), a caffeine-oleate was developed. The caffeine oleate formulation showed laboratory efficacy by causing mortality of more than 90% of CBB adults in preventive tests in which the insecticide was sprayed prior to insect attack on the coffee fruits. In the curative tests, in which spraying occurred after CBB infested the fruits, the formulation caused 77% mortality of the insects. Under controlled field conditions, the product kept CBB infestation below 20%, reducing the number of fruits attacked by the insect by up to 70%. In addition, no phytotoxic effects were observed in coffee plants. The insecticide was also effective against M. velezangeli, causing 100% mortality. A caffeine oleate formulation that could be part of a strategy for integrated CBB management as well as other pests of coffee was developed. The components of the insecticide are food grade, and the product would provide greater security to the coffee ecosystem and coffee growers.

Alzheimer’s disease (AD) and Parkinson’s disease (PD) are the two most common neurodegenerative diseases in the elderly. The key histopathological features of these diseases are the presence of abnormal protein aggregates and the progressive and irreversible loss of neurons in specific brain regions. The exact mechanisms underlying the etiopathogenesis of AD or PD remain unknown, but there is extensive evidence indicating that excessive generation of reactive oxygen species (ROS) and reactive nitrogen species (RNS), along with a depleted antioxidant system, mitochondrial dysfunction, and intracellular Ca2+ dyshomeostasis, plays a vital role in the pathophysiology of these neurological disorders. Due to an improvement in life expectancy, the incidence of age-related neurodegenerative diseases has significantly increased. However, there is no effective protective treatment or therapy available but rather only very limited palliative treatment. Therefore, there is an urgent need for the development of preventive strategies and disease-modifying therapies to treat AD/PD. Because dysregulated Ca2+ metabolism drives oxidative damage and neuropathology in these diseases, the identification or development of compounds capable of restoring Ca2+ homeostasis and signaling may provide a neuroprotective avenue for the treatment of neurodegenerative diseases. In addition, a set of strategies to control mitochondrial Ca2+ homeostasis and signaling has been reported, including decreased Ca2+ uptake through voltage-operated Ca2+ channels (VOCCs). In this article, we review the modulatory effects of several heterocyclic compounds on Ca2+ homeostasis and trafficking, as well as their ability to regulate compromised mitochondrial function and associated free-radical production during the onset and progression of AD or PD. This comprehensive review also describes the chemical synthesis of the heterocycles and summarizes the clinical trial outcomes.

Introducción. La arteria basilar se forma de las arterias vertebrales, cursa sobre el puente y se bifurca originando las arterias cerebrales posteriores. Irriga parte del tronco encefálico, cerebelo, tálamo y los lóbulos occipitales y temporales cerebrales. Su obstrucción es rara (1% de los accidentes isquémicos), puede ocurrir en cualquier parte de su trayecto, con cuadro clínico diverso. En jóvenes se añaden otros factores de riesgo distintos a los cardiovasculares, se incluye el consumo de sustancias psicoactivas. El objetivo de este artículo es presentar el caso de un adulto joven, su evolución posterior a la intervención endovascular y la asociación, pasada por alto, al consumo de cannabinoides. Caso clínico. Individuo de 23 años con 14 horas de parálisis facial periférica derecha, diplopía, disartria, hemiparesia e hiperreflexia izquierda, disfagia, náuseas y emesis. Tomografía Axial Computarizada de cráneo simple sin alteraciones. Posteriormente, al realizarse resonancia magnética nuclear, se evidencia isquemia pontomesencefálica y focos isquémicos agudos lacunares en lóbulos cerebelosos. Se consideró comprometido el territorio de la arteria basilar, por lo que se realizó angiotomografía que evidenció una obstrucción crítica de dicho vaso a nivel del tercio distal. Se realizó trombectomía con stent-retriever con recanalización total de la arteria basilar con flujo en toda su extensión. Al egreso fue clasificado como TOAST idiopático. Conclusiones. Las escalas etiológicas para stroke creadas para adultos mayores sobreestiman la etiología idiopática en pacientes jóvenes, lo cual puede ocasionar que el consumo de cannabis sea pasado por alto como causante pese a la asociación reportada por la literatura. Introduction. The basilar artery is formed from the vertebral arteries, runs over the pons and bifurcates, originating the posterior cerebral arteries. It irrigates part of the brainstem, cerebellum, thalamus, and the occipital and temporal lobes of the brain. Its obstruction is rare (1% of ischemic accidents), it can occur in any part of its path, with a diverse clinical condition. In young people, other risk factors other than cardiovascular ones are added; psychoactive substance use is included. The objective of this article is to present the case of a young adult, his evolution after endovascular intervention and the association, overlooked, to the consumption of cannabinoids. Clinical case. 23-year-old man with 14 hours of right peripheral facial paralysis, diplopia, dysarthria, left hyperreflexia and hemiparesis, dysphagia, nausea and emesis. Simple skull Computerized Axial Tomography without alterations. Subsequently, when a nuclear magnetic resonance was performed, pontomesencephalic ischemia and acute lacunar ischemic foci in the cerebellar lobes were evidenced. The basilar artery territory was considered compromised, so a CT angiography was performed, which revealed a critical obstruction of said artery at the level of the distal third. A stent-retriever thrombectomy was performed with total recanalization of the basilar artery with flow in its entirety. Upon discharge, he was classified as “idiopathic” according to the TOAST classification. Conclusions. The etiological scales for stroke created for older adults overestimate idiopathic etiology in young patients, which may cause cannabis use to be overlooked as a cause despite the association reported in the literature.

Abstract Background This study evaluates the particle dispersion involved in dental procedures carried out during orthodontic treatments. Variants such as temperature and relative humidity in the dental cabinet were considered. Methods Using a particle counter, a pilot study was conducted, in which 98 consecutive recordings were made during appointments of patients undergoing orthodontic treatments. Temperature, relative humidity and particles present at the beginning (AR) and during the appointment (BR) were recorded. A control record (CR) of temperature, relative humidity and particles present was made before the start of the clinical activity. In addition to conventional statistics, differential descriptive procedures were used to analyse results, and the influence of relative humidity on particle concentration was analysed by statistical modelling with regression equations. Results The number of particles present, regardless of their size, was much higher in AR than in CR (p

En gran medida se ha hablado de la importancia del desarrollo de emprendimientos para la dinámica económica y social de un país o una región en particular; es de suma importancia entender el porqué de la necesidad de crear emprendimientos que generen cambios significativos en la realidad de la sociedad en la cual se ejecutan y con esto buscar las estrategias que permitan su sostenimiento. Se realiza una revisión de la literatura referente al desarrollo de ecosistemas de emprendimiento en diferentes territorios con el fin de presentar una reflexión en cuanto a las necesidades que existen en la ciudad de Cartagena para la adecuada articulación y fomento de emprendimientos de alto impacto. A manera de reflexión se concluye que Cartagena cuenta con los pilares necesarios para conformar un ecosistema de que fomente el emprendimiento de alto impacto pero es necesario que se trabaje desde las instituciones en la erradicación de la pobreza y se fomente la cultura emprendedora.

INTRODUCCIÓN: La encefalopatía asociada a enfermedad tiroidea autoinmune se caracteriza por un inicio insidioso de síntomas neuropsiquiátricos que incluyen alteración de la función cognoscitiva, cambios del comportamiento, crisis convulsivas y trastornos del movimiento. REPORTE DE CASO: Hombre de 69 años con antecedente de hipotiroidismo primario que consultó por dos semanas de alteración de la memoria, confusión y trastorno del lenguaje, asociados a hiperreflexia y temblor generalizado. Los estudios mostraron nivel de hormona tiroidea y títulos de anticuerpos antitiroideos elevados, líquido cefalorraquídeo con aumento de proteínas y anticuerpos antineuronales negativos, neuroimagen normal y electroencefalograma con alteraciónes inespecíficas. Posterior a descartar otras etiologías, se hizo el diagnóstico de encefalopatía asociada a enfermedad tiroidea autoinmune y se inició manejo con esteroides, con los que presentó una mejoría clínica significativa. DISCUSIÓN: La encefalopatía asociada a enfermedad tiroidea autoinmune es un trastorno complejo que requiere un diagnóstico oportuno y rápido. En todos los pacientes con síntomas neuropsiquiátricos agudos o subagudos, y sin causa clara, es pertinente solicitar un perfil de anticuerpos antitiroideos independiente de la función tiroidea basal.

The use of wood and residual biomass from forestry works is a CO2 emission-neutral source of energy that also contributes to reducing the risk of spreading forest fires, especially under Mediterranean climate. The forest stands of stone pine (Pinus pinea L.) occupies about 0.7 million hectares in the Mediterranean basin. In this study, the commercial quality of the pellets manufactured from different types of cutting residues (needles and thin branches, medium branches and bark), as well as wood from trunks and thick branches, was assessed. It was concluded that with the exclusive use of residual biomass it is not possible to obtain pellets of high commercial quality, useful for residential or industrial use. However, the highest quality pellets could be obtained by combining them with stone pine debarked wood, but in a certain proportion that differs depending on the type of residue (around 15% for bark, 30% for medium branches and less than 15% for needles and thin branches). It is recommended to take advantage of both the thick wood (trunk + thick branches) and a proportion of medium branches and bark, while in the case of needles and thinnest branches it would be more convenient to leave them in the forest for their incorporation into the soil, given their high nutrients concentration and their low quality for energetic use. The results found support a greater valorization of the biomass obtained in the stone pine fellings. In the future it will be necessary to study which is the most appropriate logistics of the silvicultural works to be able to conveniently apply the results of this study.

Introduction: Dengue is a significant public health issue in the Urabá region, accounting for 37.5% of morbidity and 41.7% of mortality resulting from dengue in the department of Antioquia (Colombia) in 2018. Clinical Practice Guidelines (CPGs) are tools based on Evidence-Based Medicine, intended for medical personnel to bridge the gap between proven intervention efficacy and clinical decision-making. This study aims to identify barriers and facilitators in the implementation of CPGs for dengue patient care by healthcare officials in the municipalities of the banana axis in the Urabá region. Methodology: From a multifaceted approach to implementation research, a mixed method study that combines qualitative and quantitative approaches, was conducted during the years 2020 and 2021, using combined instruments to identify determinants (Guide Indicative Factors, Individual factors of health professionals, Patient factors, Professional interactions, Incentives and resources, Capacity for organizational change, and lastly Social, political, and legal factors) affecting adherence to the Comprehensive Clinical Care Guide for Patients with Dengue (GACIPD). Semi-structured interviews and focus groups with healthcare workers were conducted to assess determinants based on clinical experience. Questionnaires on determinants of GACIPD adherence, using an adapted version of the Chronic Disease Implementation Checklist (TICD), were also employed. Qualitative analysis of the interviews and focus groups used a concept-based coding framework. The questionnaire responses were analyzed using Likert scaling and frequency counts of determinants within and across domains. Participants included general practitioners, other health professionals, researchers, academics, and administrators. Results: There was a total of 103 participants in focus groups, 7 in semi-structured interviews, and 136 participants through questionnaires. Among the domains studied, the identification of barriers and facilitators emphasized institutional factors and individual factors. Organizational change capacity was identified as a major barrier, with only 3.6% of respondents indicating that their institution adjusted the prioritization of adequate care according to the guideline. The GACIPD domain received the highest facilitator rating, with 66.7% acceptance due to its practicality, simplicity, clarity, documentation, and ease of implementation, despite this, only 10% of professionals completely agree that their work is in accordance with the GACIPD. The determinant of patient factors was significant in the negative perception of adherence to GACIPD. Conclusions: Although barriers outweighed facilitators for GACIPD adherence, determinants for its use were generally positive, as most participants reported it as being a complete, documented, and easy-to-implement guide. The lack of knowledge of the guidelines impacting health professional's decision making was identified as a potentially modifiable barrier, and educational strategies could be implemented to overcome it. The region requires greater emphasis on the management of chronic health conditions, comorbidities, and coinfections of dengue with other endemic diseases. Author summary: Dengue is a significant public health issue in the Urabá, this region reported around 40% of morbidity and mortality for the disease in the department of Antioquia (Colombia) in 2018. Clinical Practice Guidelines are tools intended for medical personnel to bridge the gap between proven intervention efficacy and clinical decision-making. A study was conducted s to identify determinants affecting adherence to the Comprehensive Clinical Care Guide for Patients with Dengue. Focus groups, questionnaires, and interviews were used. Participants included general practitioners, other health professionals, researchers, academics, and administrators. The barrier most frequently identified by participants was organizational change capacity, however individual health professionals also identified a lack of interest in self-learning and knowledge of the guidelines. On the other hand, among facilitators, they identified the guideline's inherent characteristics. Although barriers outweighed facilitators for GACIPD adherence, determinants for its use were generally positive, as most participants reported it as being a complete, documented, and easy-to-implement guide. The lack of interest in self-learning and knowledge of the guidelines was identified as a potentially modifiable barrier and educational strategies could be implemented to overcome it. [ABSTRACT FROM AUTHOR]

Advanced chronic liver disease (ACLD) is associated with a wide spectrum of immune dysfunction. The clinical impact of SARS-CoV-2 on the development of decompensation and immune response in unvaccinated outpatients has not as yet been clearly defined. This study aimed to evaluate the clinical and immunological impact of SARS-CoV-2 on outpatients with ACLD. This is an observational case–control study, in which ACLD outpatients were included prospectively and consecutively and classified into two groups: SARS-CoV-2 infected and non-infected. Patients' baseline characteristics and infection data were collected and analyzed. Immunoglobulin G (IgG) levels against Spike 1 were evaluated. The primary endpoint was risk of liver decompensation during follow-up, assessed after propensity score matching and adjusted by Cox regression. Between October 2020 and July 2021, ACLD outpatients (n = 580) were identified, and 174 patients with clinical follow-up were included. SARS-CoV-2 infection incidence was 7.6% (n = 44). Risk of liver decompensation was significantly higher after infection (HR = 2.43 [1.01–5.86], p = 0.048) vs. non-infection. The time of IgG evaluation was similar in all patients (n = 74); IgG concentrations were significantly higher in compensated vs. decompensated patients (1.02 ± 0.35 pg/mL vs. 0.34 ± 0.16 pg/mL, p < 0.0001) and correlated with hemoglobin levels. The dysregulation of the innate immune response in patients with decompensated liver disease increased the risk of further decompensation following SARS-CoV-2, mainly due to a worsening of ascites. [ABSTRACT FROM AUTHOR]

Introduction: Inappropriate sinus tachycardia (IST) is a common condition with frequently not tolerated beta‐blockers or ivabradine and a high rate of complication in ablation strategy; we describe an alternative anatomical approach of sinus node (SN) modulation. Methods: This retrospective study describes a case series of 6 patients from two centers diagnosed with symptomatic IST undergoing SN ablation. Results: The mean age was 40.6 ± 13.9 years; five of the six patients were female, 100% of patients reported heart palpitations, and 66% reported dizziness, the average heart rate (HR) on a 24‐h Holter was 93.2 ± 7.9 bpm. HR during the first stage of a stress test using a standard Bruce protocol was 150 ± 70 bpm, The average HR on 24‐h Holter postablation was 75 ± 5.6 bpm, the sinus rate HR during stage 1 of a Bruce protocol exercise stress test was 120 ± 10 bpm. Conclusion: This is the first case series reporting the acute and long‐term results of a novel anatomical approach for SN modulation to treat IST targeting the arcuate ridge (AR) under intracardiac echography (ICE) guidance. The novel anatomic ICE‐guided catheter ablation approach aimed to identify the earliest activation at the AR with an extension of RF lesions toward its septal region seems effective and safe to modulate the SN in symptomatic patients with IST refractory to medical treatment. [ABSTRACT FROM AUTHOR]