Case report: Unveiling a less severe congenital nephrotic syndrome in a Rapa Nui patient with a NPHS1 Maori founder variant.

Background: Congenital nephrotic syndrome (CNS) is a severe kidney disorder characterized by edema, massive proteinuria, and hypoalbuminemia that manifests in utero or within three months after birth. CNS affects 1-3 per 100,000 children, primarily associated with genetic variants and occasionally with infections. Genetic analysis is the first-line method for diagnosis. The most common founder variants have been identified in European populations, often resulting in end-stage kidney disease by 1-2 years of age. Case-diagnosis/treatment: A female full-term neonate, without prenatal signs of kidney disease, was admitted to Rapa Nui (Eastern Island) Hospital at the age of 2 months due to bronchial obstruction. She presented fever, oliguria, edema, urine protein-to-creatinine ratio (UPCR) 433.33, and hypoalbuminemia (0.9 g/dL). She was transferred to a mainland Chilean hospital following CNS diagnosis. Viral screening detected cytomegalovirus (CMV) positivity in both blood and urine. A kidney biopsy revealed interstitial nephritis and diffuse podocyte damage and the tissue PCR resulted negative for CMV. Interviews with the parents revealed consanguinity, suggestive of hereditary CNS. Genetic analysis identified the Maori founder variant, NPHS1 c.2131C>A (p.R711S), in homozygosis. The patient received albumin infusions and antiviral therapy, being discharged when she was 5 months old, with improved laboratory parameters evidenced by UPCR 28.55, albumin 2.5 g/dL, and cholesterol 190 mg/dL. Subsequent clinical monitoring was conducted through virtual and in-person consultations. At her last follow-up at 4 years 2 months old, she presented UPCR 16.1, albumin 3.3 g/dl and cholesterol 220 mg/dL, maintaining normal kidney function and adequate growth. Conclusions: To our knowledge, this represents the first case of CNS in Chile carrying a NPHS1 variant associated with prolonged kidney survival. As described in the Maori population, the patient exhibited a less severe clinical course compared to classical NPHS1 patients. Genetic testing for the Maori founder variant in CNS patients related to the New Zealand population, could impact management decisions and potentially prevent the need for nephrectomies.

Influence of storage variables on the antioxidant and antitumor activities, phenolic compounds and vitamin C of an agglomerate of Andean berries.

Berry consumption is increasing worldwide due to their high content of bioactive compounds. However, such fruits have a very short shelf life. To avoid this drawback and to offer an effective alternative for its consumption at any time of the year, an agglomerated berry powder mix (APB) was developed. The aim of this work was to evaluate the stability of APB during a 6-months-period storage at 3 temperatures. The stability of APB was determined by moisture, aw, antioxidant activity, total phenolics, total anthocyanins, vitamin C, color, phenolic profiles, and MTT assay. APB showed differences in antioxidant activity between 0 and 6 months. It experimented non-enzymatic browning, which was more remarkable at 35 °C. APB at time 0 exhibited growth inhibitory effects against HT-29 human cancer cells. Most properties were significantly modified by storage temperature and time, which induces a significant decreasing of bioactive compounds.

Screening of Lesser-Known Salted-Dried Fish Species for Fatty Acids, Tocols, and Squalene.

The fillets and roes of 29 species of dry-salted fishes consumed in Eurasian countries were analyzed for fatty acids (FAs), tocols, and squalene, looking for derived health benefits. FAs were analyzed by GC-FID, and tocols and squalene were analyzed by HPLC-DAD. With some exceptions, docosahexaenoic (DHA, 22:6n-3), eicosapentaenoic (EPA, 20:5n-3), and arachidonic (ARA, 20:4n-6) acids were the prominent polyunsaturated fatty acids (PUFAs). The fillets of Scardinius erythrophthalmus reached the highest amounts of total FAs, ARA, and DHA (23.1, 1.82, and 2.49 mg/100 g). The fillets of Seriola quinqueradiata showed the highest percentages of DHA (34.4% of total FAs). Nutritional quality indices for fish lipids were favorable in all samples, especially the n-6/n-3 PUFA ratio, which was below 1 in most cases. α-Tocopherol was found in all fillets and roes, especially in Cyprinidae and Pleuronectidae species, and the highest value was found in the roes of Abramis brama (5.43 mg/100 g). Most samples contained tocotrienols at trace levels. The fillets of Clupeonella cultriventris contained the highest amounts of squalene (1.83 mg/100 g). Overall, dry-salted fish stand out due to their high concentrations of ARA, EPA, and DHA, as well as for α-tocopherol concentrations in roes.

Arecaceae Seeds Constitute a Healthy Source of Fatty Acids and Phenolic Compounds.

Seeds of most Arecaceae species are an underutilized raw material that can constitute a source of nutritionally relevant compounds. In this work, seeds of 24 Arecaceae taxa were analyzed for fatty acids (FAs) by GC-FID, for phenolics by HPLC-DAD and LC-MS, and for their antitumor activity against the HT-29 colorectal cancer cell line by the MTT assay. Lauric, oleic, and linoleic acids were the prominent FAs. Cocoseae species contained total FAs at 28.0-68.3 g/100 g seeds, and in other species total FAs were from 1.2 (Livistona saribus) to 9.9 g/100 g (Washingtonia robusta). Sabal domingensis, Chamaerops humilis, and Phoenix dactylifera var. Medjool had unsaturated/saturated FA ratios of 1.65, 1.33-1.78, and 1.31, respectively, and contained 7.4, 5.5-6.3, and 6.4 g FAs/100 g seeds, respectively. Thus, they could be used as raw materials for healthy oilseed production. Phenolics ranged between 39 (Livistona fulva) and 246 mg/100 g (Sabal palmetto), and of these, caffeic acid, catechin, dactylifric acid, and rutin had the highest values. (-)-Epicatechin was identified in most seed extracts by LC-MS. Hydroalcoholic extracts from five species showed a dose-dependent inhibitory effect on HT-20 cells growth at 72 h (GI50 at 1533-1968 µg/mL). Overall, Arecaceae seeds could be considered as a cheap source of health-promoting compounds.

Effects of a Home-Based Exercise Program on Health-Related Quality of Life and Physical Fitness in Dementia Caregivers: A Randomized Controlled Trial.

Regular exercise can be an effective health-promotion strategy to improve the physical and mental health of informal caregivers. A randomized controlled trial study was designed to evaluate the effects of a 9-month home-based exercise intervention on health-related quality of life (HRQoL) and physical fitness in female family caregivers of persons with dementia. Fifty-four female caregivers were randomly assigned to two groups for the 9-month study period. Participants of the intervention group (n = 25) performed two 60-min exercise sessions per week at home, under the direct supervision of a personal trainer. Participants in the control group (n = 23) continued their habitual leisure-time activities. HRQoL was assessed using the SF-36 questionnaire, and physical fitness was measured using a battery of appropriate fitness tests. After 9 months, significant improvements were observed in general health, social function, vitality, hand and leg strength, trunk flexor and extensor endurance, and aerobic endurance in the intervention group. The present intervention was highly adherent and safe for the participants, with no dropout related to the intervention. As a home-based exercise program conducted by a personal trainer face to face, it can be considered as a feasible and appropriate method to improve the most deficient HRQoL dimensions and contribute to preserving the functional capacity of female family caregivers of persons with dementia.

Buglossoides spp. seeds, a land source of health-promoting n-3 PUFA and phenolic compounds.

Ahiflower oil© is extracted from the seeds of Buglossoides arvensis, which contains high amounts of stearidonic acid (SDA, 18:4n-3), while its phenolic composition still is unreported. Moreover, several Buglossoides taxa remain unstudied and could become natural sources of SDA. In this work, seeds of several Buglossoides taxa and Ahiflower oil© were screened for fatty acids, phenolic compounds, and in vitro antiproliferative activities against colorectal cancer cells. Four flavonoids and 16 phenolic acids were identified and quantified. Among Buglossoides taxa, the highest amounts of phenolic compounds were found in samples collected in Spain, under a warm Mediterranean climate. Rosmarinic and lithospermic acids were the main phenols found in Buglossoides seeds. The MTT assay showed dose- and time-dependent inhibitory effects of B. arvensis extracts on HT-29 cancer cells, with a GI50value of ∼280 µg/mL after 72 h of cell exposure to seed extracts. The latter showed lower antiproliferative activity than that of pure phenolics due to the simultaneous presence of other compounds in the extracts, as evidenced by 1H NMR. This work constitutes the first approach to evaluate the seeds of several Buglossoides taxa as functional oils-providers to use them as functional foods.

Metabarcoding data of prokaryotes and eukaryotes inhabiting the phosphogypsum stockpiles on the salt marshes of Huelva (SW Spain).

Around 100 Mt of phosphogypsum (PG) of extreme acidity and with high concentrations of heavy metals and radionuclides have been deposited on the salt marshes of the Tinto River estuary in Huelva (SW Spain) for more than forty years. The microbial community able to thrive in these adverse conditions remains totally unknown, despite the fact that it can highly influence the biogeochemical cycle of the phosphogypsum components and include new species with biotechnological interest. High throughput sequencing of 16S/18S rRNA encoding genes is a potent tool to uncover the microbial diversity of extreme environments. This data article describes for the first time the prokaryotic and eukaryotic diversity of two water samples collected in the Huelva phosphogypsum stacks. The raw amplicons of the 16S/18S rRNA maker genes for the two phosphogypsum samples and two reference samples (seawater and the Tinto River water) obtained after sequencing on MiSeq platform are provided. The operational taxonomic units (OTUs) obtained after the treatment and clustering of the obtained reads with the QIIME2 pipeline and their taxonomic assignation performed by comparison with the SILVA database are also presented to complete the information of the article "Exploring the microbial community inhabiting the phosphogypsum stacks of Huelva (SW, Spain) by a high throughput 16S/18S rDNA Sequencing approach".

Exploring the microbial community inhabiting the phosphogypsum stacks of Huelva (SW SPAIN) by a high throughput 16S/18S rDNA sequencing approach.

Around 100 Mt of phosphogypsum (PG) have been deposited in large stacks on the salt marshes of the Tinto River estuary in Huelva (SW Spain), covering about 1000 ha. These stacks contain extremely acidic water (pH < 2) with high concentrations of pollutants which can cause emissions into their surroundings, generating important environmental concerns. Despite many chemical, geological or hydrological studies have been conducted to characterize the PG stacks of Huelva, the microbial community inhabiting this extreme environment remains unexplored. Using a 16S/18S-rRNA-high throughput sequencing approach, we have uncovered the main taxonomic groups able to live in the acidic metal-contaminated water, which is in direct contact with the PG, demonstrating for the first time the existence of a huge diversity of microbial species in these extreme conditions. In addition, the physicochemical characteristics of the water sampled have been analyzed. These studies have revealed that the most abundant bacteria found in two different leachate samples of the PG stacks belong to the genera Acidiphilium, Pseudomonas, Leptosprillum, Acidithrix, or Acidithiobacillus, typically found in acid mine drainage (AMD) environments, which in total represent around 50% of the total bacterial community. Biodiversity of eukaryotes in PG water is lower than that of prokaryotes, especially in the water collected from the perimeter channel that surrounds the PG stacks, where the pH reaches a value of 1.5 and the activity concentrations exceed 300 Bq L-1 for 238U or 20 Bq L-1 for 210Po, values which are from four to five orders of magnitude higher than those usually found in unperturbed surface waters. Even so, an unexpected diversity of algae, fungi, and ciliates have been found in the PG stacks of Huelva, where chlorophyte microalgae and basidiomycetes fungi are the most abundant eukaryotes. Additional bioinformatics tools have been used to perform a functional analysis and predict the most common metabolic pathways in the PG microbiota. The obtained data indicate that the extreme conditions of these PG stacks hide an unexpected microbial diversity, which can play an important role in the dynamics of the contaminating compounds of the PG and provide new strains with unique biotechnological applications.

Gamma-linolenic Acid from Fifty-seven Ribes Species and Cultivars.

γ-linolenic acid (GLA, 18:3n-6) is a bioactive fatty acid (FA) that exerts several healthy actions; however, its occurrence is restricted to a few oils. The goal of this study was to detect GLA-rich Ribes species and cultivars (cv), and to achieve this the seeds of 7 Ribes taxa and 50 Ribes cv were surveyed for FA profiles. The highest GLA percentages were found in R. nigrum cv 'Plotnokistnaya', 'Volshebnica', 'Atlant' and 'Nara' (22.6, 22.1, 20.9, and 20.0% of total FA, respectively) and also in R. komarovii (19.6%) and R. nigrum var. sibiricum (18.3%). Stearidonic acid (SDA, 18:4n-3) had the highest values in both R. rubrum 'Konstantinovskaya' and R. niveum 'Smolyaninovskaya' (4.8%). GLA content ranged from 0.4 in some R. rubrum cv and R. niveum 'Smolyaninovskaya' to 3.5 g/100 g seeds in R. nigrum 'Plotnokistnaya'. Principal component analysis (PCA) was performed using PUFA profiles, which allowed grouping Ribes sections as well as black currant cv derived from different pedigree within the section Coreosma. All taxa and cv checked here are valuable by-product sources, given the high GLA percentages contained in their seed oils. Such cv could be used for healthy oils production, as well as for breeding to obtain new cv with improved GLA concentrations.

Bypass of Booming Inputs of Urban and Sludge-Derived Microplastics in a Large Nordic Lake.

Microplastic research, initially focusing on marine environments, left freshwater ecosystems largely unexplored. Freshwaters are also vulnerable to microplastics and are likely the largest microplastic supplier to the ocean. However, microplastic sources, transport pathways, and fluxes at the catchment level remain to be quantified, compromising efficient actions toward mitigation and remediation. Here we show that 70-90% of microplastics reaching Norway's largest lake, originating primarily from urban waste mismanagement and sludge application on crops, continue their journey toward the ocean without being buried. Indeed, our microplastic budget for the catchment shows that out of the 35.9 tons (7.4-119.4 t) of microplastics annually released into the lake, only 3.5 tons (1.3-8.8 t) are settling to the lake bottom. The spatial and vertical microplastic distribution and diversity in lake sediments, the socio-economic modeling of plastic fluxes and spatial information on land use and potential plastic sources all point toward urban and agricultural areas as emission hotspots of increasing importance. We conclude that the degree to which lake sediments represent a net microplastic sink is likely influenced by the nature of microplastics the lake receives, and ultimately on their origin.

LED Enhances Plant Performance and Both Carotenoids and Nitrates Profiles in Lettuce.

Recent studies show that vegetables at early stage of development contain higher amounts of phytonutrients and minerals, and lower amounts of nitrates than at fully developed stage. Nevertheless, the effects of some spectrum light on the carotenoid content of lettuce microgreens are unknown. Three different LED lamps were checked: (i) artificial white light (T0); (ii) continuous light-emitting diodes with longer blue-wavelength (T1), and (iii) continuous light-emitting diodes with longer red-wavelength (T2). Different lettuce cvs. were grown under the above described lamps. Plants were collected after 10, 15, 35 and 50 days from planting to produce sprouts, microgreens, initial baby leaf, and baby leaf, respectively. Response to different continuous spectrum lights related to productivity and nitrate content was variable for the different plants. Accumulation of nitrates at initial stages in plant tissues was clearly lower than at final stages of crop development, ranging from 50.2 to 73.4 mg 100 g1 fresh weight for T2. Lettuce consumption is preferable at microgreen stage in comparison with baby leaf stage. Nitrate amounts at microgreen stage were lower than in baby leaf stage, and this content was inversely correlated with carotenoid content, which in tissues was higher at microgreens stage influenced by LED.

Mertensia (Boraginaceae) seeds are new sources of γ-linolenic acid and minor functional compounds.

In this work, seeds from selected Mertensia species were analyzed for γ-linolenic acid-rich oils and minor functional compounds. Fatty acids (FA) were analyzed by GC-FID; tocopherols, sterols, squalene, and phenolics compounds by HPLC-DAD, and the structures of the latter were confirmed by LC-MS. M. maritima spp. asiatica and M. sibirica showed the highest amounts of γ-linolenic acid (22.8 and 18.7%, respectively) and total FA (15.9 and 10.9 g/100 g seeds, respectively). M. sibirica had the greatest levels of sterols, phenolics and tocopherols (244.8, 243.9 and 66.3 mg/100 g, respectively), in which stigmasterol, rosmarinic acid and α-tocopherol (237.7, 180.1 and 53.6 mg/100 g, respectively) were the most abundant components. M. maritima spp. asiatica and M. arizonica showed the highest amounts of squalene (2.5 and 1.1 mg /100 g seeds). Mertensia species constitute a new source of GLA-rich oils, suitable to be marketed by the pharmaceutical and food industries.

Treatment of faecal incontinence with autologous expanded mesenchymal stem cells: results of a pilot study.

AIM: Management of faecal incontinence (FI) remains challenging because no definitive optimal treatment for this condition has yet been determined. Regenerative medicine could be an attractive therapeutic alternative for treating FI. Here, we aimed to determine the safety and feasibility of autologous expanded mesenchymal stem cells derived from adipose tissue (AdMSCs) in the treatment of patients diagnosed with structural FI. METHOD: This was a randomized, multicentre, triple-blinded, placebo-controlled pilot study conducted at four sites in Spain with 16 adults with FI and a sphincter defect. Autologous AdMSCs were obtained from patients from surgically excised adipose tissue. These patients were intralesionally infused with a single dose of 4 × 107 AdMSCs or a placebo while under anaesthesia. We assessed the safety and feasibility of the treatment as the cumulative incidence of adverse events and the treatment efficacy using the Cleveland Clinic Faecal Incontinence Score, Faecal Incontinence Quality of Life score and Starck criteria to classify sphincter defects and anorectal physiology outcomes. RESULTS: Adipose tissue extraction, cell isolation and intralesional infusion procedures were successful in all the patients. There was only one adverse event connected to adipose tissue extraction (a haematoma), and none was associated with the injection procedure. There were no significant differences in any of the assessed clinical, manometric or ultrasonographic parameters. CONCLUSION: This study indicates that this infusion procedure in the anal sphincter is feasible and safe. However, it failed to demonstrate efficacy to treat patients with structural FI.

γ-Linolenic and Stearidonic Acids from Boraginaceae of Diverse Mediterranean Origin.

Thirty Boraginaceae species from different tribes were evaluated in a search of γ-linolenic (GLA, 18:3n-6) and stearidonic acid (SDA, 18:4n-3)-rich oils. The high GLA percentages were found in the seed oils of Symphytum bulbosum and S. tuberosum subsp. tuberosum (27.6 and 27.2 % of total fatty acids (FA)), which are unusually high values for GLA-oils in the current literature. On the whole seed, noticeable GLA percentages were found in S. grandiflorum, S. tuberosum subsp. tuberosum and Borago officinalis (7.43, 4.90, and 4.51 g/100 g, respectively). The main SDA-taxa detected in this study were Buglossoides arvensis, B. incrassata and Glandora oleifolia (21.3, 18.9, and 16.3 % of total fatty acids). On total seed weight, Glandora rosmarinifolia showed the highest SDA content (3.57 g/100 g). Finally, the higher FA contents were found in S. grandiflorum and Paramoltkia doerfleri seeds (35.2 and 37.0 g/100 g, respectively). Principal component analysis showed that similarities in FA profiles allow grouping species as botanical criteria for Boraginaceae tribes do, while the FA groupings confirm the metabolic activities of desaturase and elongase enzymes. Data on the FA composition of the seed oils analyzed here suggest their potential use as functional foods and can be considered as novel sources of SDA and GLA.

α-Linolenic and γ-linolenic acids exercise differential antitumor effects on HT-29 human colorectal cancer cells.

α-Linolenic acid (ALA, 18:3n-3) and γ-gamma linolenic acid (GLA, 18:3n-6) are polyunsaturated fatty acids (PUFA) that improve the human health. The present study focused on testing the in vitro antitumor actions of pure ALA and GLA on the HT-29 human colorectal cancer cell line. Cell viability was checked by MTT ((3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) test, cell membrane damage by the lactate dehydrogenase assay, apoptosis was tested by both caspase-3 activity trial and transmission electron microscopy images, and protein composition was analyzed by quantitative proteomics analysis. MTT test revealed IC50 values of 230 and 255 µM for ALA and GLA, respectively, at 72 h. After 24 h of incubation, both ALA and GLA induced apoptosis on HT-29 colorectal cancer cells according to the caspase-3 assay and microscopy images. SWATH/MS analysis evidenced that ALA significantly affected the mitochondrial protein import pathway and the citric acid cycle pathway, while GLA did not significantly affect any particular pathway. In summary, both ALA and GLA showed concentration-dependent inhibitory effects on HT-29 cells viability and induced cell death by apoptosis. ALA significantly affected cellular pathways, while GLA does not have specific actions on either pathway. Both n-3 and n-6 C18 PUFA are bioactive food components useful in the colorectal cancer prevention.

Características y resultados tras un año en pacientes ancianos ingresados con insuficiencia cardiaca y fracción de eyección reducida, intermedia o conservada / Characteristics and one-year outcomes in elderly patients hospitalised with heart failure and preserved, mid-range and reduced ejection fraction

INTRODUCCIÓN: La última guía de insuficiencia cardiaca (IC) de la Sociedad Europea de Cardiología define 3 tipos de IC según la fracción de eyección (FE): FE reducida (ICFEr) cuando FE<40%, FE intermedia (ICFEi), cuando FE 40-49%, y FE conservada (ICFEc) cuando FE≥50%. El objetivo es analizar las características y resultados de los ancianos ingresados con IC según la nueva categorización por la FE. MÉTODOS: Estudio prospectivo con 531 pacientes diagnosticados de IC, categorizados según la FE, mayores de 75 años e ingresados en 6 servicios de Geriatría en España. Se analizan las características demográficas, clínicas y las comorbilidades, así como la morbimortalidad al año de seguimiento. RESULTADO: Un 17,1% de los pacientes se encuadraron en ICFEr, 10% en ICFEi y 72,9% en ICFEc. Aquellos con ICFEi eran similares a los de ICFEr en cuanto a la menor edad, predominio de hombres e ingreso previo por IC, así como en el uso de fármacos para el bloqueo neurohormonal. En los pacientes con ICFEr, respecto a aquellos con ICFEi e ICFEc, se objetivó mayor porcentaje de muertes (35,2, 24,5 y 25,1%), reingresos por IC (17,6, 15,1 y 14,2%) y eventos (59,3, 45,3 y 50,6%), aunque no hubo diferencias significativas. Tampoco se observaron diferencias en el análisis de supervivencia entre los grupos de FE y las variables de resultados tiempo-dependientes. CONCLUSIONES: En ancianos hospitalizados con IC, los categorizados como ICFEi no muestran claras diferencias en las características clínicas respecto a aquellos con ICFEr o ICFEc. No hubo diferencias en cuanto a la morbimortalidad

INTRODUCTION: The latest European Society of Cardiology Heart Failure (HF) guidelines define three types of HF according to the ejection fraction (EF): HF with reduced EF (HFrEF) when EF<40%, HF with mid-range EF (HFmrEF), when EF 40-49%, and HF with preserved EF (HFpEF) when EF≥50%. The objective of this study was to analyse the characteristics and results of elderly patients hospitalised with HF according to the new classification using EF. METHODS: A prospective study was carried out with 531 HF patients aged ≥75 years classified according to EF, and admitted in the geriatric wards of 6 hospitals in Spain. An analysis was performed on the demographic and clinical characteristics, as well as well as the morbidity and mortality at one year of follow-up. RESULTS: As regards EF, 17.1% had HFrEF, 10% had HFmrEF, and 72.9% had HFpEF. Patients with HFmrEF were more similar to those with HFrEF in terms of a younger age, predominance of men, and previous admission due to HF. This was also the case with the use of drugs for neurohormonal blockade. Patients with HFrEF (compared to those with HFmrEF and HFpEF), had higher mortality (35.2%, 24.5%, and 25.6%, respectively), more readmissions for HF (17.6%, 15.1%, and 14.5%, respectively), and more events (61.5%, 45.3%, and 52.5%, respectively), although there were no significant differences. There were also no differences observed in the survival analysis between the EF groups and the time-dependent outcome variables. CONCLUSIONS: In elderly patients hospitalised with HF, those classified as HFmrEF did not show any clear differences with respect to those with HFrEF or HFpEF. There were no differences in terms of morbidity and mortality

Geriatría transversal. Un reto asistencial para el siglo XXI / Cross-speciality geriatrics: A health-care challenge for the 21st century

Cada vez es mayor el número de pacientes de edad avanzada que está siendo tratado por especialidades diferentes a la geriatría, las cuales, por las características de sus tratamientos, necesitan conocer el pronóstico que tiene su indicación en los pacientes ancianos frágiles y optimizar la situación de estos pacientes para mejorar dicho pronóstico. Las más frecuentes, actualmente, son oncología y hematología, cardiología, cirugía general y otros servicios quirúrgicos. Se entiende por geriatría transversal la ampliación del área de conocimiento y atención de la geriatría en sentido horizontal, fuera de sus unidades habituales, aplicando los principios de la medicina geriátrica con un enfoque multidisciplinar al terreno de otros servicios que atienden a pacientes muy mayores y frágiles con enfermedades graves, con el objetivo de ofrecer una atención centrada en la persona y mejorar su manejo integral. La valoración geriátrica y la detección de la fragilidad en estos casos aportan información pronóstica y ayudan en la toma de decisiones y en la selección de un tratamiento individualizado. En algunos casos es posible mejorar la evolución de los pacientes y la eficiencia del sistema sanitario. En este artículo se revisan estos conceptos, se describen algunos modelos existentes, se mencionan los instrumentos más empleados para esta función y se resumen algunas actividades de esta nueva área de la asistencia geriátrica. Es previsible que cada vez en más hospitales se solicite a los servicios de geriatría la implementación de este tipo de valoraciones e intervenciones. Existe información básica para su puesta en marcha, pero no la suficiente como para considerar que están respondidas todas las preguntas que se plantean. Será, pues, en los próximos años un nuevo reto para esta especialidad

Increasing numbers of older persons are being treated by specialties other than Geriatric Medicine. Specialists turn to Geriatric Teams when they need to accurately stratify their patients' risk and prognosis, predict the potential impact of their, often, invasive interventions, optimise their clinical status, and contribute to discharge planning. Oncology and Haematology, Cardiology, General Surgery, and other surgical departments are examples where such collaborative working is already established, to a varying extent. The use of the term "Cross-speciality Geriatrics" is suggested when geriatric care is provided in clinical areas traditionally outside the reach of Geriatric Teams. The core principles of Geriatric Medicine (comprehensive geriatric assessment, patient-centred multidisciplinary targeted interventions, and input at point-of-care) are adapted to the specifics of each specialty and applied to frail older patients in order to deliver a holistic assessment/treatment, better patient/carer experience, and improved clinical outcomes. Using Comprehensive Geriatric Assessment methodology and Frailty scoring in such patients provides invaluable prognostic information, helps in decision making, and enables personalised treatment strategies. There is evidence that such an approach improves the efficiency of health care systems and patient outcomes. This article includes a review of these concepts, describes existing models of care, presents the most commonly used clinical tools, and offers examples of excellence in this new era of geriatric care. In an ever ageing population it is likely that teams will be asked to provide Cross-specialty Geriatrics across different Health Care systems. The fundamentals for its implementation are in place, but further evidence is required to guide future development and consolidation, making it one of the most important challenges for Geriatrics in the coming years

[Characteristics and one-year outcomes in elderly patients hospitalised with heart failure and preserved, mid-range and reduced ejection fraction]. / Características y resultados tras un año en pacientes ancianos ingresados con insuficiencia cardiaca y fracción de eyección reducida, intermedia o conservada.

INTRODUCTION: The latest European Society of Cardiology Heart Failure (HF) guidelines define three types of HF according to the ejection fraction (EF): HF with reduced EF (HFrEF) when EF<40%, HF with mid-range EF (HFmrEF), when EF 40-49%, and HF with preserved EF (HFpEF) when EF≥50%. The objective of this study was to analyse the characteristics and results of elderly patients hospitalised with HF according to the new classification using EF. METHODS: A prospective study was carried out with 531 HF patients aged ≥75 years classified according to EF, and admitted in the geriatric wards of 6 hospitals in Spain. An analysis was performed on the demographic and clinical characteristics, as well as well as the morbidity and mortality at one year of follow-up. RESULTS: As regards EF, 17.1% had HFrEF, 10% had HFmrEF, and 72.9% had HFpEF. Patients with HFmrEF were more similar to those with HFrEF in terms of a younger age, predominance of men, and previous admission due to HF. This was also the case with the use of drugs for neurohormonal blockade. Patients with HFrEF (compared to those with HFmrEF and HFpEF), had higher mortality (35.2%, 24.5%, and 25.6%, respectively), more readmissions for HF (17.6%, 15.1%, and 14.5%, respectively), and more events (61.5%, 45.3%, and 52.5%, respectively), although there were no significant differences. There were also no differences observed in the survival analysis between the EF groups and the time-dependent outcome variables. CONCLUSIONS: In elderly patients hospitalised with HF, those classified as HFmrEF did not show any clear differences with respect to those with HFrEF or HFpEF. There were no differences in terms of morbidity and mortality.

Evaluation of the radioactive pollution in the salt-marshes under a phosphogypsum stack system.

Next to the city of Huelva (SW of Spain), around 100 Mt of phosphogypsum (PG) are stored in stacks on the salt-marshes of the Tinto River estuary covering a surface of about 1000 ha. Due to the high content of 238U series natural radionuclides of the PG, its acidic nature (pH about 3), and the fact that PG stacks were disposed without any kind of isolation from the substrate, they could produce a potential radioactive impact into the underlying sediments. The aim of this work is to assess the pollution of the underlying sediments by natural radionuclides coming from the PG stacks. To this end, seven cores were taken, and PG and sediments samples collected at different depths were analysed. The activity concentrations of the main long half-live natural radionuclides of interest were determined by applying both gamma-ray and alpha-particle spectrometry radiometric techniques. The results of this study showed that the first decimeters of salt-marsh sediment act as a "barrier" for the radionuclides coming from the PG stacks decreasing rapidly its activity concentration in depth, affecting mainly sediments located in the first 20 cm below the contact due to mixing processes. While 230Th, 226Ra and 210Pb pollution is mainly restricted to the first 20 cm of sediments, U-isotopes can reach higher depths (up to around 50 cm) by leaching processes due to their lower reactivity and higher concentration in the polluted leachates. The obtained results have high relevance for the design of the perimeter channel which is projected to build in the restoration project, suggesting that should has around 1 m deep under the base of the PG stacks, to ensure the full collection of polluting leachates, and to prevent their release into the estuary of the Tinto River.