Frailty predicts adverse outcomes in older patients with pulmonary embolism.

AIM: This study aims to evaluate the impact of frailty on the outcomes of older patients with pulmonary embolism (PE). METHODS: Using the National Inpatient Sample database, we identified 288 070 patients aged 65 or older who were admitted with a primary diagnosis of PE from 2017 to 2019. Frailty was assessed using the Hospital Frailty Risk Score (HFRS), and patients were categorized into low-, intermediate-, and high-frailty-risk groups. Multivariate logistic regression was used to calculate adjusted odds ratios for all outcomes. RESULTS: These patients were categorized into low-risk (57.6%, 161 420), medium-risk (39.9%, 111 805), and high-risk (2.5%, 7075) groups. High-risk patients, predominantly females with multiple comorbidities, exhibited significantly higher mortality rates and adverse outcomes. The HFRS showed a good discriminating ability in predicting mortality (area under the receiver operating characteristic curve = 0.7796). Frailty was associated with increased use of advanced therapeutic interventions and critical care resources such as thrombolysis, catheter-directed therapies, inferior vena cava filter placement, mechanical ventilation, vasopressor use, and intensive care unit admission. CONCLUSION: Frailty markedly affects outcomes in older PE patients. The HFRS offers a valuable prognostic tool in this population, suggesting that integrating frailty assessments into clinical practice could enhance care strategies and improve patient outcomes. Our findings underscore the need for further research to refine frailty-based care paradigms. Geriatr Gerontol Int 2024; ••: ••-••.

Draft genome sequence of Agarivorans aestuarii strain ZMCS4, a putative CAZyme-producing bacteria isolated from the marine brown algae Cladostephus spongiosus.

We report the draft genome sequence of Agarivorans aestuarii strain ZMCS4, isolated from Cladostephus spongiosus. The assembled genome consists of 4.5 Mbp, comprising 25 contigs and 4,128 coding sequences. This genome will provide insights into further studies on relevant CAZymes involved in the hydrolysis of algal cell walls.

Intraoperative vascular air embolism and intracardiac thrombosis complicating liver transplantation: a case report.

BACKGROUND: Intracardiac thrombus and vascular air embolism represent rare complications in the context of orthotopic liver transplantation. While isolated reports exist for intracardiac thrombus and vascular air embolism during orthotopic liver transplantation, this report presents the first documentation of their simultaneous occurrence in this surgical setting. CASE PRESENTATION: This case report outlines the clinical course of a 60-year-old white female patient with end-stage liver disease complicated by portal hypertension, ascites, and hepatocellular carcinoma. The patient underwent orthotopic liver transplantation and encountered concurrent intraoperative complications involving intracardiac thrombus and vascular air embolism. Transesophageal echocardiography revealed the presence of air in the left ventricle and a thrombus in the right atrium and ventricle. Successful management ensued, incorporating hemodynamic support, anticoagulation, and thrombolytic therapy, culminating in the patient's discharge after a week. CONCLUSIONS: This report highlights the potential for simultaneous intraoperative complications during orthotopic liver transplantation, manifesting at any phase of the surgery. It underscores the critical importance of vigilant monitoring throughout orthotopic liver transplantation to promptly identify and effectively address these rare yet potentially catastrophic complications.

Association between Impella device support and elevated rates of gout flares: a retrospective propensity-matched study.

BACKGROUND: Impella is an advanced ventricular assist device frequently used as a bridge to heart transplantation. The association of Impella with increased rates of gout flares has not been studied. Our primary aim is to determine the rates of gout flares in patients on Impella support. METHODOLOGY: A retrospective study was conducted between January 2017 and September 2022 involving all patients who underwent heart transplantation. The cohort was divided into two groups based on Impella support for statistical analysis. In patients receiving Impella support, outcome measures were compared based on the development of gout flares. 1:1 nearest neighbor propensity match, as well as inverse propensity of treatment weighted analyses, were performed to explore the causal relationship between impella use and gout flare in our study population. RESULTS: Our analysis included 213 patients, among which 42 (19.71%) patients were supported by Impella. Impella and non-Impella groups had similar age, race, and BMI, but more males were in the Impella group. Gout and chronic kidney disease were more prevalent in Impella-supported patients, while coronary artery disease was less common. The prevalence of gout flare was significantly higher in Impella patients (30.9% vs. 5.3%). 42 Impella-supported patients were matched with 42 patients from the non-impella group upon performing a 1:1 propensity matching. Impella-supported patients were noted to have a significantly higher risk of gout flare (30.9% vs. 7.1%, SMD = 0.636), despite no significant difference in pre-existing gout history and use of anti-gout medications. Impella use was associated with a significantly increased risk of gout flare in unadjusted (OR 8.07), propensity-matched (OR 5.83), and the inverse propensity of treatment-weighted analysis (OR 4.21). CONCLUSION: Our study is the first to identify the potential association between Impella support and increased rates of gout flares in hospitalized patients. Future studies are required to confirm this association and further elucidate the biological pathways. It is imperative to consider introducing appropriate measures to prevent and promptly manage gout flares in Impella-supported patients.

Monitoring Arthropods in maize and pasture fields in São Miguel and São Jorge Islands: IPM-Popillia Project.

Background: The dataset presented here is an achievement of the H2020 European project "Integrated Pest Management of the Invasive Japanese Beetle, Popilliajaponica (IPM-Popillia)". This project addresses the challenge of a new risk to plant health in Europe, the invasion of the Japanese beetle, Popilliajaponica (Newman, 1838) (Coleoptera, Rutelidae) and provides an environmentally friendly IPM Toolbox to control the expanding pest populations across Europe. This study aims to present the records of terrestrial arthropod diversity with a special focus on four groups belonging to Carabids and Staphylinid beetles (Coleoptera), Opiliones and Anisolabididae (Dermaptera), collected with the potential to be used as biocontrol agents against P.japonica in future Integrated Pest Management programmes. A thorough sampling programme was conducted in maize and pasture fields in two Islands of the Azores (São Miguel and São Jorge) in the summer of 2022. New information: We provided an inventory of the arthropods recorded in two Azorean agroecosystems (maize and pasture fields) from São Miguel and São Jorge Islands. A total of ten maize and ten pasture fields were sampled and a total of 360 pitfall traps were installed, 216 in São Miguel and 144 in São Jorge, for seven consecutive days in August and September of 2022.We collected 18559 specimens belonging to the phylum Arthropoda, four classes, twelve orders, twenty-six families and forty morphospecies (two identified at the family level as carabid and Staphylinid larvae and 38 identified at the species level). We identified 38 taxa at the species level (n = 18281). Of the 38 identified taxa, 18 species were predators, 15 were plant feeders and five were omnivores. The 18 predators belong to the following families: 10 species were Carabidae, two Staphylinidae, one Anisolabididae, one Chrysopidae, one Leiobunidae, one Nabidae, one Phalangiidae and one Scathophagidae. Concerning the origin of the predators, we recorded five native species: two Carabidae, one Leiobunidae, one Scathophagidae and one Nabidae. The other 13 predator species were introduced or indeterminate.

Pneumothorax, pneumomediastinum, and subcutaneous emphysema in hospitalized COVID-19 patients: incidence, clinical characteristics, and outcomes.

BACKGROUND: Limited data is available on the incidence and outcomes of pneumothorax (PTX), pneumomediastinum (PNM), and subcutaneous emphysema (SCE) in COVID-19 patients. This study aimed to investigate the characteristics of these complications in hospitalized COVID-19 patients. RESEARCH DESIGN AND METHODS: A retrospective study was conducted, involving adult COVID-19 patients admitted to Mayo Clinic Florida from 03/2020-06/2022. Patients were divided into two groups based on the presence or absence of PTX/PNM/SCE. RESULTS: 1926 hospitalized patients with COVID-19 were included, of which 518 were admitted to the ICU. The incidence of PTX/PNM/SCE was 6.3%. Patients with these complications were more likely to be male, Asian, and unvaccinated. Conversely, they were less likely to have chronic obstructive pulmonary disease. Patients who developed PTX/PNM/SCE after 72 hours of admission were more likely to receive high-dose corticosteroids and for an extended duration. The affected group had an adjusted odds ratio for in-hospital mortality of 13.32 (95%CI, 8.19-21.59) and ICU admission of 9.14 (95%CI, 5.3-12.78) compared to the unaffected group. CONCLUSION: Although the occurrence of PTX/PNM/SCE in hospitalized COVID-19 patients was rare, it was associated with worse outcomes. Corticosteroids may contribute to the pathogenesis of these complications; however, further studies are needed to investigate this relationship in more detail.

Exploring Gut Microbiome Variations between Popillia japonica Populations of Azores.

Popillia japonica (Coleoptera: Scarabaeidae), is an emerging invasive pest in Europe and America. In the Azores, this pest was first found on Terceira Island during the sixties and soon spread to other islands. The rate of infestation differs between islands, and we hypothesized that microbiome composition could play a role. Therefore, we sampled 3rd instar larvae and soil from sites with high and low infestation rates to analyze the microbiome using next-generation sequencing. We analyzed twenty-four 16S DNA libraries, which resulted in 3278 operational taxonomic units. The alpha and beta diversity of the soil microbiome was similar between sites. In contrast, the larvae from high-density sites presented a higher bacterial gut diversity than larvae from low-density sites, with biomarkers linked to plant digestion, nutrient acquisition, and detoxification. Consequently, larvae from high-density sites displayed several enriched molecular functions associated with the families Ruminococcaceae, Clostridiaceae and Rikenellaceae. These bacteria revealed a supportive function by producing several CAZyme families and other proteins. These findings suggest that the microbiome must be one drive for the increase in P. japonica populations, thus providing a checkpoint in the establishment and spread of this pest.

A ShK-like Domain from Steinernema carpocapsae with Bioinsecticidal Potential.

Entomopathogenic nematodes are used as biological control agents against a broad range of insect pests. We ascribed the pathogenicity of these organisms to the excretory/secretory products (ESP) released by the infective nematode. Our group characterized different virulence factors produced by Steinernema carpocapsae that underlie its success as an insect pathogen. A novel ShK-like peptide (ScK1) from this nematode that presents high sequence similarity with the ShK peptide from a sea anemone was successfully produced recombinantly in Escherichia coli. The secondary structure of ScK1 appeared redox-sensitive, exhibiting a far-UV circular dichroism spectrum consistent with an alpha-helical secondary structure. Thermal denaturation of the ScK1 allowed estimating the melting temperature to 59.2 ± 0.1 °C. The results from toxicity assays using Drosophila melanogaster as a model show that injection of this peptide can kill insects in a dose-dependent manner with an LD50 of 16.9 µM per adult within 24 h. Oral administration of the fusion protein significantly reduced the locomotor activity of insects after 48 h (p < 0.05, Tukey's test). These data show that this nematode expresses insecticidal peptides with potential as next-generation insecticides.

Purification and Characterization of a Thrombolytic Enzyme Produced by a New Strain of Bacillus subtil.

Fibrinolytic enzymes with a direct mechanism of action and safer properties are currently requested for thrombolytic therapy. This paper reports on a new enzyme capable of degrading blood clots directly without impairing blood coagulation. This enzyme is also non-cytotoxic and constitutes an alternative to other thrombolytic enzymes known to cause undesired side effects. Twenty-four Bacillus isolates were screened for production of fibrinolytic enzymes using a fibrin agar plate. Based on produced activity, isolate S127e was selected and identified as B. subtilis using the 16S rDNA gene sequence. This strain is of biotechnological interest for producing high fibrinolytic yield and consequently has potential in the industrial field. The purified fibrinolytic enzyme has a molecular mass of 27.3 kDa, a predicted pI of 6.6, and a maximal affinity for Ala-Ala-Pro-Phe. This enzyme was almost completely inhibited by chymostatin with optimal activity at 48°C and pH 7. Specific subtilisin features were found in the gene sequence, indicating that this enzyme belongs to the BPN group of the S8 subtilisin family and was assigned as AprE127. This subtilisin increased thromboplastin time by 3.7% (37.6 to 39 s) and prothrombin time by 3.2% (12.6 to 13 s), both within normal ranges. In a whole blood euglobulin assay, this enzyme did not impair coagulation but reduced lysis time significantly. Moreover, in an in vitro assay, AprE127 completely dissolved a thrombus of about 1 cc within 50 min and, in vivo, reduced a thrombus prompted in a rat tail by 11.4% in 24 h compared to non-treated animals.

Bioactive Excreted/Secreted Products of Entomopathogenic Nematode Heterorhabditis bacteriophora Inhibit the Phenoloxidase Activity during the Infection.

Entomopathogenic nematodes (EPNs) are efficient insect parasites, that are known for their mutualistic relationship with entomopathogenic bacteria and their use in biocontrol. EPNs produce bioactive molecules referred to as excreted/secreted products (ESPs), which have come to the forefront in recent years because of their role in the process of host invasion and the modulation of its immune response. In the present study, we confirmed the production of ESPs in the EPN Heterorhabditis bacteriophora, and investigated their role in the modulation of the phenoloxidase cascade, one of the key components of the insect immune system. ESPs were isolated from 14- and 21-day-old infective juveniles of H. bacteriophora, which were found to be more virulent than newly emerged nematodes, as was confirmed by mortality assays using Galleria mellonella larvae. The isolated ESPs were further purified and screened for the phenoloxidase-inhibiting activity. In these products, a 38 kDa fraction of peptides was identified as the main candidate source of phenoloxidase-inhibiting compounds. This fraction was further analyzed by mass spectrometry and the de novo sequencing approach. Six peptide sequences were identified in this active ESP fraction, including proteins involved in ubiquitination and the regulation of a Toll pathway, for which a role in the regulation of insect immune response has been proposed in previous studies.

MHC class II transcription is associated with inflammatory responses in a wild marine mammal.

Inflammation is one of the most important non-specific and rapid responses that a vertebrate can elicit in response to damage or a foreign insult. To date, despite increasing evidence that the innate and adaptive branches of immunity are more intricately related than previously thought, few have examined interactions between the Major Histocompatibility Complex (MHC, a polymorphic region of the vertebrate genome that is involved with antigen presentation) and inflammation, and even less is known about these interactions in an eco-immunological context. Here, we examined the effect of MHC class II DRB gene multiplicity and transcription on phytohemagglutinin (PHA)-induced inflammation during the early stages of development of California sea lions. Neither constitutive nor expressed ZacaDRB diversity was found to be associated with pup responses to PHA at any of the stages of pup development. However, for two-month-old pups, those with a specific MHC-DRB locus (ZacaDRB-A) tended to have less efficient responsive inflammation. Transcription of distinct MHC-DRB loci was also linked to PHA-induced inflammation, with patterns that varied markedly between ages, and that suggested that ongoing infectious processes could limit the capacity to respond to a secondary challenge. Life history constraints and physiological processes associated with development of California sea lions, in conjunction with their changing pathogenic environment could explain the observed effects of MHC class II transcription on PHA-induced inflammation. To our knowledge, ours is the first study to examine the importance of expressed vs. constitutive MHC loci on inflammation in a natural population.

Transformation of the genital epithelial tract occurs early in California sea lion development.

An unusually high prevalence of metastatic urogenital carcinoma has been observed in free-ranging California sea lions stranded off the coast of California in the past two decades. No cases have been reported for sea lions in the relatively unpolluted Gulf of California. We investigated occurrence of genital epithelial transformation in 60 sea lions (n=57 pups and 3 adult females) from the Gulf of California and examined whether infection by a viral pathogen previously found to be associated with urogenital carcinoma accounted for such alterations. We also explored the contribution of MHC class II gene expression on transformation. Cellular alterations, such as squamous cell atypia (ASC), atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions were observed in 42% of the pups and in 67% of the adult females. Normal genital epithelium was more common in male than female pups. ASC was five times more likely to occur in older pups. Epithelial alterations were unrelated to infection by the potentially oncogenic otarine type I gammaherpesvirus (OtHV-1), but ASCUS was more common in pups with marked and severe inflammation. Expression of MHC class II DRB loci (Zaca DRB-D) by peripheral antigen-presenting leucocytes showed a slightly 'protective' effect for ASC. We propose that transformation of the California sea lion genital epithelium is relatively common in young animals, increases with age and is probably the result of infection by an unidentified pathogen. Expression of a specific MHC class II gene, suggestive of presentation of specific antigenic peptides to immune effectors, appears to lower the risk of transformation. Our study provides the first evidence that epithelial transformation of the California sea lion genital tract is relatively common, even from an early age, and raises questions regarding differences in sea lion cancer-detection and -repair success between geographical regions.

Involvement of the AATn polymorphism of the CNR1 gene in the efficiency of procedural learning in humans.

Procedural learning refers to the acquisition of motor skills and the practice that refines their performance. The striatum participates in this learning through a function regulated by endocannabinoid signaling and other systems. This study relates the efficiency in learning a procedural task with the AATn polymorphism of the CNR1 gene, which encodes for the CB1 receptor. The mirror-drawing star task was solved by 99 healthy young subjects in three trials. The sample was divided into high- and low-performance groups based on performance efficiency. AAT12/14 carriers were more frequent in the former group, while there were more AAT12/13 carriers in the latter, which also made more errors/min. Therefore, we characterized two efficiency phenotypes: high- vs. low-performers associated with the two AATn genotypes, AAT12/14 vs. AAT12/13. The findings suggest that AATn polymorphism modifies CNR1 translation, indicating a different modulation of CB1.

Analgesia regional interpleural con bupivacaína al 0.5 por ciento en postoperatorio de colecistectomía / Interpleural regional analgesia with bupivacaine 0.5 percent in postoperative pain management of colecystectomy

Al revisar la literatura acerca del dolor postoperatorio (DPO), se encuentra una persistencia en el inadecuado manejo del mismo. Las consecuencias del DPO no controlado conducen a una lenta recuperación postoperatoria (PO), particularmente en cirugía de tórax y abdomen superior. En el presente estudio se valora la analgesia regional interpleural en el manejo del DPO en pacientes sometidos a colecistectomía. Se estudiaron 23 pacientes de diferentes edades y pesos, masculino y femenino, estado físico ASA I y II, sometidos a colecistectomía abierta, incisión subcostal, bajo anestesia general balanceada. Al finalizar la ciruguía y anestesia se coloco un catéter epidural en el espacio interpleural a nivel del 7º espacio intercostal, en la línea axilar posterior, a través de una aguja Touhy calibre 16, por la que se administró Bupivacaína al 0.5 por ciento 100 mg + Epinefrina 100 µg. Se valoró la analgesia lograda a las 2, 4, 6 y 8 horas mediante la Escala Visual Análoga (EVA) y la Escala Príncipe Henry del dolor (EPH). Además se registro el inicio, máxima y duración de analgesia excelente en 100 por ciento de los casos en las primeras 2 horas del PO. Analgesia buena o regular (30-70 EVA) a las 8 horas. El inicio. máxima y duración de analgesia se encontró a los 61.95 segs, 31.73 min. y 7.56 horas respectivamente. Se concluye que la analgesia regional interpleural es un eficaz método alternativo en el manejo del DPO en colecistectomía abierta, abordaje subcostal

Fracturas del tercio proximal del fémur. Revisión de ciento ochenta y cinco casos / Fractures of the femur proximal third. Review of 185 cases

Se realiza un estudio de 185 casos de pacientes con fractura del tercio proximal del fémur, tratados en el servicio de ortopedia del Hospital Docente "Comandante Manuel Fajardo". Se observa al computar el índice de ocurrencia por sexo, que en el femenino es superior, y en su mayoría es en personas de edad avanzada. Estudiamos las fracturas por región anatómica, y se hace constar la frecuencia notable de las transcervicales e intertrocantéreas en relación con el resto. Se relacionan los diferentes tipos de fracturas y las distintas técnicas practicadas, así como los pacientes no intervenidos quirúrgicamente por causas familiares o médicas. Se enumeran posibles complicaciones durante los períodos pre y posoperatorios y las causas de defunción. Se señala lo difícil que resulta la localización periódica de estos enfermos para chequeos despues del año de operados, motivo por ei que sólo se señalan los casos no satisfactorios; asimismo se relacionan las causas que corresponden, tanto al enfermos como al cirujano(AU)