Cardiac function is under the control of the autonomic nervous system, composed by the parasympathetic and sympathetic divisions, which are finely tuned at different hierarchical levels. While a ...complex regulation occurs in the central nervous system involving the insular cortex, the amygdala and the hypothalamus, a local cardiac regulation also takes place within the heart, driven by an intracardiac nervous system. This complex system consists of a network of ganglionic plexuses and interconnecting ganglions and axons. Each ganglionic plexus contains numerous intracardiac ganglia that operate as local integration centres, modulating the intricate autonomic interactions between the extrinsic and intracardiac nervous systems. Herein, we summarize the current understanding on the intracardiac nervous system, and acknowledge its role in the pathophysiology of cardiovascular diseases.
•The intracardiac nervous system (ICNS) plays a crucial role in cardiac physiology.•Cardiovascular diseases (CVD) cause pathological changes in intracardiac neurons.•More studies are needed in this area in order to know how ICNS can underpin CVD.•A better understanding of the ICNS may help to develop new treatments for CVD.•This paper reviews the role and current knowledge of ICNS in CVD.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Introduction: Proper nutrition during pregnancy is important to prevent nutritional imbalances that interfere with pregnancy. Micronutrients play critical roles in embryogenesis, fetal growth, and ...maternal health, as energy, protein, vitamin, and mineral needs can increase during pregnancy. Increased needs can be met by increasing the intake of dietary micronutrients. Severe micronutrient deficiency or excess during pregnancy can have negative effects on fetal growth (intrauterine growth retardation, low birth weight, or congenital malformations) and pregnancy development (pre-eclampsia or gestational diabetes). We investigate whether it is necessary to continue micronutrient supplementation during pregnancy to improve women’s health in this stage and whether this supplementation could prevent and control pathologies associated with pregnancy. Aim: The present review aims to summarize evidence on the effects of nutritional deficiencies on maternal and newborn morbidity. Methods: This aim is addressed by critically reviewing results from published studies on supplementation with different nutrients during pregnancy. For this, major scientific databases, scientific texts, and official webpages have been consulted. PubMed searches using the terms “pregnancy” OR “maternal-fetal health” AND “vitamins” OR “minerals” OR “supplementation” AND “requirement” OR “deficiency nutrients” were performed. Results: There are accepted interventions during pregnancy, such as folic acid supplementation to prevent congenital neural tube defects, potassium iodide supplementation to correct neurodevelopment, and oral iron supplementation during the second half of pregnancy to reduce the risk of maternal anemia and iron deficiency. A number of micronutrients have also been associated with pre-eclampsia, gestational diabetes mellitus, and nausea and vomiting in pregnancy. In general, experimental studies are necessary to demonstrate the benefits of supplementation with different micronutrients and to adjust the recommended daily doses and the recommended periconceptional nutrition for mothers. Conclusions: Presently, there is evidence of the benefits of micronutrient supplementation in perinatal results, but indiscriminate use is discouraged due to the fact that the side effects of excessive doses are not known. Evidence supports the idea that micronutrient deficiencies negatively affect maternal health and the outcome of pregnancy. No single micronutrient is responsible for the adverse effects; thus, supplementing or correcting one deficiency will not be very effective while other deficiencies exist.
•Evaluation of the influence of temperature on NIRS calibration of sodium in cured ham.•NIRS calibration models are sensitive to changes in temperature.•A global temperature compensation model shows ...good NIR prediction for application.
Temperature fluctuations are a key factor in the development of prediction models using near infrared spectroscopy (NIRS). In the present study, this influence has been investigated and a methodology has been proposed to reduce the effect of sample temperature on NIRS model prediction of the sodium content in dry-cured ham slices. Spectra were taken directly from the slices using a remote measurement probe (for non-contact analysis) at three different temperature ranges: −12 °C to −5°C, −5°C to 10 °C and 10 °C to 20 °C. Local and global temperature compensation methods were established. Partial-least squares (PLS) regression was used as a chemometrics tool to perform the calibrations. The results showed that local models were sensitive to changes in temperature, while a global temperature model using sample spectra over the entire temperature range showed good prediction ability, reducing the error caused by temperature fluctuations to acceptable levels for practical applications.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
We evaluated whether indications for liver transplantation (LT) have changed among people with/without human immunodeficiency virus (HIV) infection and compared LT outcomes and trends by HIV ...serostatus. LT recipients (2008–2018) from the United Network for Organ Sharing and Organ Procurement and Transplantation Network (UNOS/OPTN) were identifed. Among 62 195 LT recipients, 352 (0.6%) were HIV‐infected. The proportion of HIV‐infected patients increased over time (P trend = .001), as did the number of transplant centers performing LT for HIV‐infected recipients; average annual percentage change of 9.2% (p < .001). Nonviral causes became the leading indication in 2015 for HIV‐uninfected and in 2018 for HIV‐infected (P trend < .001). Three‐year cumulative patient survival rates were 77.5%, for HIV‐infected and 84.6%, for HIV‐uninfected (p = .15). Over time, graft and patient survival rates improved for both HIV‐infected and uninfected (p < .001). Among HCV‐infected LT recipients, 3‐year patient survival rates were 72.5% for HIV‐infected and 81.8% for HIV‐uninfected (p = .02). However, in a subanalysis restricted to 2014–2018, differences in graft and patient survival by HIV serostatus were no longer observed (3‐year patient survival rates were 81.2% for HIV‐infected and 86.4% for HIV‐uninfected, p = .34). In conclusion, in the United States, nonviral liver disease is now the leading indication for LT in HIV‐infected patients, and posttransplant outcomes have improved over time.
Analyses of the UNOS/OPTN database show that nonviral liver disease is now the leading indication for liver transplantation in HIV‐infected patients and that posttransplant outcomes have improved over time. See the editorial on page 2931.
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BFBNIB, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The critical situation of domestic wastewater treatment in the rural areas of Brazil stimulates the development or improvement of on-site systems using cheap and sustainable materials that can be ...applied in small and isolated communities. Although this is an important theme, few real scale systems have been studied. This study investigated a full-scale on-site domestic wastewater treatment system composed of a septic tank, an anaerobic filter filled with green coconut husks (Cocos nucifera) and an intermittent sand filter. The experiment was conducted in a rural area located in the city of Campinas (Brazil) and the system was built to serve a small community. The quality of the effluent generated by this combination is in accordance with Brazilian and European legislation and even allows for its reuse in agricultural activities. The results also demonstrate the feasibility of using coconut husks in anaerobic filters, providing a new and more sustainable destination for this material, which is normally treated as solid waste. The combination was shown to be a viable technology for small communities.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract
Background
Thousands of people suffer from anxiety, depression, and insomnia every day, with benzodiazepines being one of the strategies used to treat these conditions. Withdrawal from its ...long-term use can lead to potentially life-threatening complications, including Takotsubo syndrome. The authors highlight an atypical case of Takotsubo syndrome secondary to benzodiazepine withdrawal, a rare life-threatening complication of acute substance withdrawal.
Case summary
A 58-year-old female presented to the emergency department with altered mental status and acute pulmonary oedema after discontinuing her prescribed benzodiazepines 3 days prior to presentation. Electrocardiogram (ECG) demonstrated anterior ST-segment elevation, with Q-wave and T-wave inversion with prolonged QT interval. Troponin I concentration and B-type natriuretic peptide were elevated to 5407 ng/L (normal ≤ 16 ng/L) and to 1627.0 pg/L (normal ≤ 100 pg/mL), respectively. Echocardiogram showed ballooning of the left ventricle (LV) apex with dyskinesia of the mid and apical segments, with LV function of 15%. Coronary angiography was normal, but left ventriculography showed severe LV systolic dysfunction with akinesis of the mid and apical LV segments and hyperdynamic basal segments. A presumptive diagnosis of benzodiazepine withdrawal–induced Takotsubo syndrome was made, and patients’ symptoms, ECG findings, and LV dysfunction resolved after benzodiazepine administration. Six months post discharge, the patient remained asymptomatic with a normal biventricular function, and a beta-blocker was successfully introduced as part of a lifelong plan.
Discussion
A diagnosis of benzodiazepine withdrawal–induced Takotsubo syndrome is an underrecognized and challenging diagnosis, due to its atypical clinical presentation. High degree of clinical suspicion for this syndrome is crucial, since favourable prognosis depends on prompt diagnosis and treatment.
Recommended post‐liver transplant (LT) prophylaxis in patients with hepatitis delta includes a nucleos(t)ide analogue (NA) and anti‐hepatitis B immunoglobulin (HBIG) indefinitely. We analysed the use ...of HBIG in real‐life clinical practice and its impact on HBV/HDV recurrence in 174 HDV‐related LT patients from 10 Spanish liver transplant centres (1988–2018). Median post‐LT follow‐up was 7.8 (2.3–15.1) years and patient survival at 5 years was 90%. Most patients (97%) received HBIG in the immediate post‐LT, but only 42% were on HBIG at the last control. Among those discontinuing HBIG, the median time on treatment was 18 (7–52) months. Post‐LT HBsAg+ was detected in 16 (9%) patients and HBV‐DNA in 12 (7%). Despite HBsAg positivity, HDV recurrence was reported only in three patients (1.7%), all of whom were not receiving NA and had discontinued HBIG. Our data suggest that a finite HBIG prophylaxis in HDV‐LT is feasible, especially if high‐barrier NAs are used.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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