Hyperglycemia exacerbates ischemic stroke not through increased generation of hydrogen peroxide.

Diabetes is one of the significant risk factors for ischemic stroke. Hyperglycemia exacerbates the pathogenesis of stroke, leading to more extensive cerebral damage and, as a result, to more severe consequences. However, the mechanism whereby the hyperglycemic status in diabetes affects biochemical processes during the development of ischemic injury is still not fully understood. In the present work, we record for the first time the real-time dynamics of H2O2 in the matrix of neuronal mitochondria in vitro in culture and in vivo in the brain tissues of rats during development of ischemic stroke under conditions of hyperglycemia and normal glucose levels. To accomplish this, we used a highly sensitive HyPer7 biosensor and a fiber-optic interface technology. We demonstrated that a high glycemic status does not affect the generation of H2O2 in the tissues of the ischemic core, while significantly exacerbating the consequences of pathogenesis. For the first time using Raman microspectroscopy approach, we have shown how a sharp increase in the blood glucose level increases the relative amount of reduced cytochromes in the mitochondrial electron transport chain in neurons under normal conditions in awake mice.

Difficult diagnosis in the ICU: making the right call but beware uncertainty and bias.

Dealing with an uncertain or missed diagnosis is commonplace in the intensive care unit setting. Affected patients are subject to a potential decrease in quality of care and a greater risk of a poor outcome. The diagnostic process is a complex task that starts with information gathering, followed by integration and interpretation of data, hypothesis generation and, finally, confirmation of a (hopefully correct) diagnosis. This may be particularly challenging in the patient who is critically ill where a good history may not be forthcoming and/or clinical, laboratory and imaging features are non-specific. The aim of this narrative review is to analyse and describe common causes of diagnostic error in the intensive care unit, highlighting the multiple types of cognitive bias, and to suggest a diagnostic framework. To inform this review, we performed a literature search to identify relevant articles, particularly those pertinent to unclear diagnoses in patients who are critically ill. Clinicians should be cognisant as to how they formulate diagnoses and utilise debiasing strategies. Multidisciplinary teamwork and more time spent with the patient, supported by effective and efficient use of electronic healthcare records and decision support resources, is likely to improve the quality of the diagnostic process, patient care and outcomes.

Current Perspectives on the Role of TNF in Hematopoiesis Using Mice With Humanization of TNF/LT System.

TNF is a multifunctional cytokine with its key functions attributed to inflammation, secondary lymphoid tissue organogenesis and immune regulation. However, it is also a physiological regulator of hematopoiesis and is involved in development and homeostatic maintenance of various organs and tissues. Somewhat unexpectedly, the most important practical application of TNF biology in medicine is anti-TNF therapy in several autoimmune diseases. With increased number of patients undergoing treatment with TNF inhibitors and concerns regarding possible adverse effects of systemic cytokine blockade, the interest in using humanized mouse models to study the efficacy and safety of TNF-targeting biologics in vivo is justified. This Perspective discusses the main functions of TNF and its two receptors, TNFR1 and TNFR2, in steady state, as well as in emergency hematopoiesis. It also provides a comparative overview of existing mouse lines with humanization of TNF/TNFR system. These genetically engineered mice allow us to study TNF signaling cascades in the hematopoietic compartment in the context of various experimental disease models and for evaluating the effects of various human TNF inhibitors on hematopoiesis and other physiological processes.

Could the results of posterior colporrhaphy and levatoroplasty be improved by abdominal sacrocolporectopexy?

AIM: The aim of our study was to improve poor results of preliminary colporrhaphy and anterior levatoroplasty performed for patients with low and middle rectocele. MATIRIAL OF STUDY: 55 patients who had undergone colporrhaphy and anterior levatoroplasty for rectocele in 2012- 2015 and contacted the clinic with complaints of ongoing obstructive defecation were included in this investigation. They had a comprehensive medical examination using defecography, ultrasound, magnetic resonance imaging, anorectal functional tests. This study revealed perineum descending in 20 patients, apical prolapse 23 patients, and 12 patients demonstrated simultaneous pathology. All these patients were performed additional abdominal sacrocolporectopexy in 2015-2017 and results were estimated. RESULTS: Abdominal sacrocolporectopexy significantly improved anatomical and functional results of previous surgery which was confirmed by the listed methods of research. The average location of the anorectal area and utero-cervical zone became higher. So, perineum descendents and apical prolapsed were improved. DISCUSSION: Sacrocolporectopexy is often used for surgical treatment of pelvic organ prolapse. Our study shows its efficiency in patients with perineum descending and upper rectocele. CONCLUSIONS: Abdominal sacrocolporectopexy is an effective method of surgical correction of relapses and unsatisfactory results of treatment of patients with pelvic prolapse, manifested by perineum body descending and apical prolapse. KEY WORDS: Apical prolapse, Levatoroplasty, Perineum descending, Rectocele, Sacrocolporectopexy.

The uncertain climate footprint of wetlands under human pressure.

Significant climate risks are associated with a positive carbon-temperature feedback in northern latitude carbon-rich ecosystems, making an accurate analysis of human impacts on the net greenhouse gas balance of wetlands a priority. Here, we provide a coherent assessment of the climate footprint of a network of wetland sites based on simultaneous and quasi-continuous ecosystem observations of CO2 and CH4 fluxes. Experimental areas are located both in natural and in managed wetlands and cover a wide range of climatic regions, ecosystem types, and management practices. Based on direct observations we predict that sustained CH4 emissions in natural ecosystems are in the long term (i.e., several centuries) typically offset by CO2 uptake, although with large spatiotemporal variability. Using a space-for-time analogy across ecological and climatic gradients, we represent the chronosequence from natural to managed conditions to quantify the "cost" of CH4 emissions for the benefit of net carbon sequestration. With a sustained pulse-response radiative forcing model, we found a significant increase in atmospheric forcing due to land management, in particular for wetland converted to cropland. Our results quantify the role of human activities on the climate footprint of northern wetlands and call for development of active mitigation strategies for managed wetlands and new guidelines of the Intergovernmental Panel on Climate Change (IPCC) accounting for both sustained CH4 emissions and cumulative CO2 exchange.

Limpieza y desinfección en el hospital / Hygiene and disinfection in the hospital

El medio ambiente, tanto animado como inanimado, es un elemento básico de la cadena epidemiológica de la transmisión nosocomial de las infecciones. La desinfección de suelos y superficies, así como la del instrumental y materiales utilizados en la práctica clínica diaria, son la primera herramienta en la lucha contra la transmisión de estas infecciones. La limpieza previa, requisito indispensable para la posterior desinfección, debe ser realizada de tal forma que garantice el resultado del proceso. De manera complementaria, el lavado de manos es una de las prácticas de antisepsia más importante, ya que las manos son el principal vehículo de transmisión de la infección nosocomial. En este trabajo se repasan los conceptos relacionados con la limpieza y desinfección en el hospital, como son la asepsia, antisepsia, niveles de desinfección, clasificación de los antisépticos y los desinfectantes, etc. También se recuerda la importancia del lavado de manos. Se exponen los principios básicos de la limpieza y desinfección de suelos, superficies y materiales, y se hace un breve repaso a los desinfectantes más frecuentemente utilizados en desinfección de alto nivel. (AU)

Enfermería en los servicios de Medicina Preventiva: funciones, actividades, responsabilidades / Nursing in the preventive medicine service: functions, activities, responsabilities

El papel de los profesionales de enfermería en los servicios de Medicina Preventiva tiene un contenido diferenciado y especializado, aunque hasta el momento carece de reconocimiento y persiste como un puesto polivalente. Ante la ausencia de una formación de 2º ciclo más especializada consideramos el desarrollo de perfiles específicos un primer paso para definir nuestros puestos de trabajo dentro del equipo preventivista, sirviendo a corto plazo de guía para las nuevas incorporaciones, y a largo plazo para potenciar el reconocimiento profesional en las diferentes áreas de trabajo. Es importante unificar el papel de todos los profesionales de enfermería en este campo para poder ofrecer al resto de nuestros compañeros una imagen sólida y competente de nuestras actividades. (AU)