Diastolic dysfunction is an independent predictor for cardiovascular events after an acute kidney injury.

BACKGROUND AND AIM: Acute kidney injury (AKI) conditions several short- and long-term complications. The aim of the present study was to analyse the impact of cardiac function and structure in the cardiovascular prognosis after an in-hospital AKI episode. MATERIAL AND METHODS: This is an observational retrospective cohorts study including all in-hospital AKI episodes in 2013 and 2014 in our centre. At baseline, epidemiological values, comorbidities and echocardiography parameters were collected. During a follow-up of 49 ±â€¯28 months, cardiovascular events (CVE) were collected, and associated factors were analysed. RESULTS: 1255 patients were included (55% male, age 75 ±â€¯13 years). Of the 676 (54%) that had a previous echocardiogram, 46% had left ventricular hypertrophy, 38% pulmonary hypertension, 38% diastolic dysfunction and 22% systolic dysfunction. During the follow-up, 484 (39%) developed a CVE. Associated factors to VCE were male sex, age, diabetes mellitus, hypertension, dyslipidemia, coronary heart disease, heart failure, atrial fibrillation, neoplasia and chronic kidney disease (also, glomerular filtration rate at baseline and after the AKI episode). Survival curves demonstrated that all the echocardiographic parameters were associated to CVE. An adjusted Cox regression model showed that age (HR 1.017), diabetes (HR 1.576) and diastolic dysfunction (HR 1.358) were independent predictors for CVE. CONCLUSION: Diastolic dysfunction is an independent predictor for long-term cardiovascular events after an in-hospital acute kidney injury episode.

La disfunción diastólica es un predictor independiente de eventos cardiovasculares tras un fracaso renal agudo / Diastolic dysfunction is an independent predictor for cardiovascular events after an acute kidney injury

Antecedente y objetivo: El desarrollo de un fracaso renal agudo (FRA) condiciona complicaciones a corto, medio y largo plazo. El objetivo de nuestro estudio fue analizar el impacto de las alteraciones cardiacas en el pronóstico cardiovascular de pacientes que presentan un episodio de FRA. Materiales y métodos: Realizamos un estudio observacional de cohortes retrospectivo incluyendo a todos los pacientes con FRA en 2013 y 2014. Basalmente recogimos variables epidemiológicas, comorbilidades y parámetros ecocardiográficos. Seguimos a los pacientes tras el ingreso durante una media de 49 ± 28 meses, recogiendo la incidencia de eventos cardiovasculares (ECV) y los factores asociados a los mismos. Resultados: Se incluyeron 1.255 pacientes (55% varones, edad 75 ± 13 años). De los 676 (54%) pacientes que disponían de un ecocardiograma previo, el 46% tenían hipertrofia de ventrículo izquierdo, el 38% hipertensión pulmonar, el 38% disfunción diastólica y el 22% disfunción sistólica. Tras la hospitalización por FRA, 484 (39%) tuvieron un ECV. Los factores asociados a presentar un ECV fueron el sexo (varón), la edad, diabetes mellitus, hipertensión arterial, dislipidemia, cardiopatía isquémica, insuficiencia cardiaca, fibrilación auricular, neoplasia previa y enfermedad renal crónica (y el filtrado glomerular estimado basal y tras el FRA). El análisis de supervivencia demostró que todos los parámetros ecocardiográficos se asociaban a ECV. Un modelo de regresión de Cox ajustado demostró que la edad (HR 1,017), la diabetes mellitus (HR 1,576) y la disfunción diastólica (HR 1,358) eran predictores independientes de ECV. Conclusiones: La disfunción diastólica es un predictor independiente de ECV a largo plazo tras un episodio hospitalario de FRA. (AU)

Background and aim: Acute kidney injury (AKI) conditions several short- and long-term complications. The aim of the present study was to analyse the impact of cardiac function and structure in the cardiovascular prognosis after an in-hospital AKI episode. Materials and methods: This is an observational retrospective cohorts study including all in-hospital AKI episoes in 2013 and 2014 in our centre. At baseline, epidemiological values, comorbidities and echocardiography parameters were collected. During a follow-up of 49 ± 28 months, cardiovascular events (CVEs) were collected, and associated factors were analysed. Results: 1255 patients were included (55% male, age 75 ± 13 years). Of the 676 (54%) that had a previous echocardiogram, 46% had left ventricular hypertrophy, 38% pulmonary hypertension, 38% diastolic dysfunction and 22% systolic dysfunction. During the follow-up, 484 (39%) developed a CVE. Associated factors to CVE were male sex, age, diabetes mellitus, hypertension, dyslipidemia, coronary heart disease, heart failure, atrial fibrillation, neoplasia and chronic kidney disease (also, glomerular filtration rate at baseline and after the AKI episode). Survival curves demonstrated that all the echocardiographic parameters were associated to CVE. An adjusted Cox regression model showed that age (HR 1.017), diabetes (HR 1.576) and diastolic dysfunction (HR 1.358) were independent predictors for CVE. Conclusion: Diastolic dysfunction is an independent predictor for long-term CVEs after an in-hospital AKI episode. (AU)

Infectious consequences of the AKI-to-CKD transition.

Background: Acute kidney injury (AKI) is associated with short- and long-term complications but the consequences of the AKI-to-CKD transition are still poorly understood. We aimed to evaluate the association between the AKI-to-CKD transition and the long-term risk of infection. Methods: This retrospective study included patients admitted in a tertiary hospital with community-acquired AKI in 2013 and 2014 who had their estimated glomerular filtration rate (eGFR) assessed at 3 months (±2 weeks) after serum creatinine peaked in the AKI episode. Key exclusion criteria were baseline CKD or confounding factors (active neoplasia, primary immunodeficiency, human immunodeficiency virus, immunosuppressive drugs). The association between the AKI-to-CKD transition (defined as an eGFR <60 ml/min/1.73 m2 at 3 months) and long-term infections (defined using clinical features, blood/urine analysis, cultures and imaging) was assessed during a follow-up of 9 months (range 2-56). Results: Among the 1731 patients admitted with AKI, 367 (21%) were included in the present analysis (64% male, 71 ± 15 years). Three months after AKI, 159 (43%) developed AKI-to-CKD transition. Baseline and post-AKI eGFR were independent predictors of AKI-to-CKD transition [hazard ratio (HR) 0.97, P = .044 and HR 0.96, P < .001, respectively].During follow-up, 153 (42%) patients developed an infection. Factors associated with infection were older age, cognitive impairment, lower post-AKI eGFR, eGFR loss from baseline to 3 months and AKI-to-CKD transition. Adjusted Cox regression showed that baseline eGFR, 3-month eGFR, eGFR loss and AKI-to-CKD transition were independent predictors of the long-term risk of infection. Conclusions: The AKI-to-CKD transition independently predicts the long-term risk of infection following an episode of AKI.

Fate of petroleum-based and plant-based teabags exposed to environmental soil conditions for one year.

Petroleum-based plastics are materials which have provided important industrial benefits from being lightweight and having low production costs. However, plastic pollution is pervasive and ubiquitous on all environments. This has led some industries to rapidly introduce the so called 'bioplastics' into the market by switching the conventional ones for new plant-based alternatives with similar properties. However, little is known about the fate of such alternatives especially in the open environment. In this novel study, the degradation of teabags from eight different brands was investigated, five petroleum based (cellulose-PP blend) and three plant-based (cellulose, cellulose-PLA blend and PLA). The degradation was tested under real-environmental soil conditions over a 12-month period. Fourier Transform Infrared Spectroscopy (FTIR-ATR) and Scanning Electron Microscopy (SEM) techniques were used to examine the change in polymer makeup and surface degradation of teabags at 3 weeks, 3.5, 6 and 12 months. Teabag dry weight and any retrieved fragments were measured over time. Teabags that contained a plastic blended to cellulose were brittle or degraded into smaller fragments after 3 weeks in soil. Parallel to this, the cellulose layer also degraded in this short timeline. Petroleum-based teabags produced the highest numbers of PP fragments overtime and fragmented teabags were still found after 12 months. Plant-based teabags made of cellulose only or a blend of cellulose-PLA were absent from soil samples after 3.5 months, including no fragments. Contrary to this, teabags made of PLA which were marketed as completely biodegradable, persisted completely intact in soil throughout all time points. The novel results from this study provide a perspective on plastic degradation in terrestrial sources. Based on these findings, it can be recommended that teabags mostly made of cellulose or cellulose blended with a bioplastic present in a smaller ratio, are a better alternative to petroleum-based or pure PLA plastics, in terms of rapid environmental degradation. Further studies should focus on their ecotoxicity, additive presence, microbial degradation and life cycle in order to draw a full environmental assessment.

Adsorption, uptake and toxicity of micro- and nanoplastics: Effects on terrestrial plants and aquatic macrophytes.

Plastic pollution is a new, pressing, environmental topic. Microplastics are considered contaminants of emerging concern and, consequently, microplastic research has grown exponentially in the last decade. Here, current knowledge regarding the impacts of micro- and nanoplastics on terrestrial plants and aquatic macrophytes is discussed, with a special focus on adsorption, uptake and toxicological effects. Our review reveals that a range of plants and macrophytes can adsorb or internalise plastic particles. Both processes depend on particle characteristics such as size and charge, as well as plant features including a sticky or hydrophobic surface layer. This finding is of concern given that plants and aquatic macrophytes are at the bottom of food webs and are a crucial component of the human diet. Therefore, there is a critical need for improved understanding of adsorption, uptake and impacts of micro- and nanoplastics, and the consequences thereof for trophic transfer, food safety and security. Also, a range of stress responses have been observed for many plant and macrophyte species after both short and long-term exposures to plastic particles. Given that some plastic particles can affect plant productivity, we surmise that plastic particles may potentially impact ecosystem productivity and function. Here we present a synthesis and a critical evaluation of the state of knowledge of micro- and nanoplastics and plants and macrophytes, identifying key questions for future research.

Beyond plastic microbeads - Short-term feeding of cellulose and polyester microfibers to the freshwater amphipod Gammarus duebeni.

Monitoring studies have revealed the presence of large numbers of natural as well as anthropogenic microfibers, plastic and non-plastic, in environmental samples. However, the interaction of organisms with microfibers is largely understudied. This is the first ecotoxicological study that compares short-term feeding of anthropogenic plastic and non-plastic microfibers on a consumer (leaf-shredding detritivores) species. The freshwater amphipod Gammarus duebeni was selected for this study as it is a model ecotoxicological species. After a 96-hour exposure, 58.3% and 41.7% of the amphipods contained cellulose or polyester fibers in their digestive tracts, respectively. Microfiber ingestion was analysed per polymers in presence or absence of food. The G. duebeni group exposed to 'polyester fibers in presence of food' accumulated highest numbers of microfibers in their digestive tracts (5.2 ±â€¯3.4 MFs/amphipod) followed by those exposed to 'cellulose in presence of food' (2.5 ±â€¯0.9 MFs/amphipod). A significantly (Three-way ANOVA, p-value <0.05) higher number of microfibers was found in the midgut-hindgut (posterior) sections, compared to the foregut (anterior) section. Microfiber uptake had no apparent short-term negative effect on amphipod survival at 96 h. Yet, as amphipods are both predators and prey, and therefore are key species in the aquatic food web, the rapid accumulation of anthropogenic microfibers in their digestive system has potentially further ecological implications. Future studies need to consider the possible transfer of ingested anthropogenic microfibers to higher trophic levels in freshwater communities.

Rapid fragmentation of microplastics by the freshwater amphipod Gammarus duebeni (Lillj.).

Microplastics have become ubiquitous in all environments. Yet, their environmental fate is still largely unknown. Plastic fragmentation is a key component of plastic degradation, which is mostly caused by abiotic processes over prolonged time scales. Here, it is shown that the freshwater amphipod Gammarus duebeni can rapidly fragment polyethylene microplastics, resulting in the formation of differently shaped and sized plastic fragments, including nanoplastics. Fragments comprised 65.7% of all observed microplastic particles accumulated in digestive tracts. Higher numbers of fragments were found in response to longer exposure times and/or higher microplastic concentrations. Furthermore, the proportion of smaller plastic fragments was highest when food was present during the depuration process. It is concluded that G. duebeni can rapidly fragment polyethylene microplastics and that this is closely associated with the feeding process. These results highlight the crucial role, currently understudied, that biota may play in determining the fate of microplastics in aquatic ecosystems.

Modified inspiratory muscle training (m-IMT) as promising treatment for gastro-oesophageal reflux disease (GERD) / Entrenamiento de músculos inspiratorios modificado como tratamiento prometedor de la enfermedad por reflujo gastroesofágico

BACKGROUND: Gastro-oesophageal reflux disease (GERD) is one of the most common diseases, but is still a challenge to cure. Different medical treatments are used, first of all Proton pump inhibitors (PPIs), however these are sometimes ineffective and long-term intake can lead to underestimated complications. Recently, some studies investigated the role of inspiratory muscle training (IMT) in the medical treatment of GERD. It seems that IMT is able to increase the pressure generated by the lower oesophageal sphincter (LES), reduce spontaneous releases of LES, acid exposure, use of PPIs, and improve symptoms and quality of life for GERD patients. OBJECTIVE: The aim of this study was to evaluate the effectiveness of IMT in association with myofunctional therapy exercises of swallowing set by Daniel Garliner (m-IMT) on the symptoms of patients with non-erosive gastro-oesophageal reflux disease (NERD). METHODS: Twenty-one adult patients with NERD were enrolled from May to December 2017 and performed m-IMT over a period of 4 weeks. Before and after treatment, all the patients completed the following questionnaires: GERD oesophageal symptomatology (GERDQ), extra-oesophageal GERD symptomatology (RSI), quality of life (GERD-Health Related Quality of Life Questionnaire (GERD-HRQL), and underwent laryngeal endoscopy. RESULTS: Nineteen patients completed m-IMT. GERDQ (from 8.36 ± 3.94 to 1.7 ± 3.41; p < .05), RSI (from to 21.68 ± 10.26 to 6.93 ± 8.37; p < .05) and GERDHRQL (from 25.68 ± 16.03 to 8.4 ± 11.06; p<.05) the questionnaire scores significantly reduced after treatment. In addition, the laryngeal endoscopy score greatly improved (from 14.24 ± 4.15 to 7.4 ± 1.77; p < .05). CONCLUSIONS: m-IMT is a low cost therapy without side effects. It could be useful in association with PPI or alone for selected GERD cases and for mild NERD forms, in association with diet. Further studies are required to prove the effects of m-IMT on GERD symptoms and decide the best treatment Schedule

INTRODUCCIÓN: La enfermedad por reflujo gastroesofágico (ERGE) es una de las enfermedades más comunes, pero sigue siendo un desafío para curar. Se utilizan diferentes tratamientos médicos, en primer lugar los inhibidores de la bomba de protones (IBP), sin embargo, en ocasiones son ineficaces y una ingesta a largo plazo puede llevar a complicaciones subestimadas. Recientemente, algunos estudios investigaron el papel del entrenamiento muscular inspiratorio (IMT) en el tratamiento médico de la ERGE. Parece que el IMT es capaz de aumentar la presión generada por el esfínter esofágico inferior (LES), reducir las liberaciones espontáneas del LES, la exposición al ácido, el uso de IBP, y mejorar los síntomas y la calidad de vida en pacientes con ERGE. OBJETIVO: El objetivo de este estudio es evaluar la efectividad de la IMT en asociación con los ejercicios de terapia miofuncional de tragar de Daniel Garliner (m-IMT) en los síntomas de los pacientes con ERGE no erosivo (NERGE). MÉTODOS: Veintiún pacientes adultos con ERGE se inscribieron de mayo a diciembre de 2017 y realizaron un período de 4 semanas de m-IMT. Antes y después del tratamiento todos los pacientes completaron los siguientes cuestionarios: sintomatología esofágica de ERGE, sintomatología de ERGE extraesofágica (RSI), calidad de vida (cuestionario de calidad de vida relacionada con la salud [ERGE-HRQL]) y endoscopia laríngea. RESULTADOS: Diecinueve pacientes completaron m-IMT. GERDQ (desde 8,36 ± 3,94 a 1,7 ± 3,41; p < 0,05), RSI (desde hasta 21,68 ± 10,26 hasta 6,93 ± 8,37; p < 0,05) y ERGE-HRQL (desde 25,68±16,03 hasta 8,4 ± 11,06; p < 0,05), las puntuaciones se redujeron significativamente después del tratamiento. Además, la puntuación de la endoscopia laríngea mejoró enormemente (de 14,24 ± 4,15 a 7,4 ± 1,77; p< 0,05). CONCLUSIONES: m-IMT es una terapia de bajo costo sin efectos secundarios. Podría ser útil en asociación con IBP o solo en casos seleccionados de ERGE y en formas NERGE leves, en asociación con la dieta. Se requieren estudios adicionales para probar los efectos de m-IMT en los síntomas de ERGE y establecer el mejor programa de tratamiento

Modified inspiratory muscle training (m-IMT) as promising treatment for gastro-oesophageal reflux disease (GERD).

BACKGROUND: Gastro-oesophageal reflux disease (GERD) is one of the most common diseases, but is still a challenge to cure. Different medical treatments are used, first of all Proton pump inhibitors (PPIs), however these are sometimes ineffective and long-term intake can lead to underestimated complications. Recently, some studies investigated the role of inspiratory muscle training (IMT) in the medical treatment of GERD. It seems that IMT is able to increase the pressure generated by the lower oesophageal sphincter (LES), reduce spontaneous releases of LES, acid exposure, use of PPIs, and improve symptoms and quality of life for GERD patients. OBJECTIVE: The aim of this study was to evaluate the effectiveness of IMT in association with myofunctional therapy exercises of swallowing set by Daniel Garliner (m-IMT) on the symptoms of patients with non-erosive gastro-oesophageal reflux disease (NERD). METHODS: Twenty-one adult patients with NERD were enrolled from May to December 2017 and performed m-IMT over a period of 4 weeks. Before and after treatment, all the patients completed the following questionnaires: GERD oesophageal symptomatology (GERDQ), extra-oesophageal GERD symptomatology (RSI), quality of life (GERD-Health Related Quality of Life Questionnaire (GERD-HRQL), and underwent laryngeal endoscopy. RESULTS: Nineteen patients completed m-IMT. GERDQ (from 8.36±3.94 to 1.7±3.41; p<.05), RSI (from to 21.68±10.26 to 6.93±8.37; p<.05) and GERDHRQL (from 25.68±16.03 to 8.4±11.06; p<.05) the questionnaire scores significantly reduced after treatment. In addition, the laryngeal endoscopy score greatly improved (from 14.24±4.15 to 7.4±1.77; p<.05). CONCLUSIONS: m-IMT is a low cost therapy without side effects. It could be useful in association with PPI or alone for selected GERD cases and for mild NERD forms, in association with diet. Further studies are required to prove the effects of m-IMT on GERD symptoms and decide the best treatment schedule.

Polyethylene microplastics adhere to Lemna minor (L.), yet have no effects on plant growth or feeding by Gammarus duebeni (Lillj.).

Microplastics (1-1000 µm) are ubiquitous in the marine, freshwater and terrestrial environments. These microsized plastics are considered freshwater pollutants of emerging concern, although the impacts on organisms and ecosystems are not yet clear. In particular, effects of microplastics on freshwater aquatic plants and the fate of microplastics in the freshwater trophic chain remain largely unexplored. Here we demonstrate that 10-45 µm polyethylene (PE) microplastics can strongly adsorb to all surfaces of the duckweed species Lemna minor. Despite adsorbance of up to 7 PE microplastics per mm2, seven day exposure experiments showed that photosynthetic efficiency and plant growth are not affected by microplastics. Rather, dense surface coverage suggests L. minor as a potential vector for the trophic transfer of microplastics. Here we show that the freshwater amphipod Gammarus duebeni can ingest 10-45 µm PE microplastics by feeding on contaminated L. minor. In this study, ingestion of microplastics had no apparent impact on amphipod mortality or mobility after 24 or 48 h exposure. Yet, the feeding study showed that the fate of microplastics in the environment may be complex, involving both plant adsorbance and trophic transfer.