ObjectivesTo characterise the comorbidities of heart failure (HF) in men and women, to explore their clustering into multimorbidity patterns, and to measure the impact of such patterns on the risk of ...hospitalisation and mortality.DesignObservational retrospective population study based on electronic health records.SettingEpiChron Cohort (Aragón, Spain).ParticipantsAll the primary and hospital care patients of the EpiChron Cohort with a diagnosis of HF on 1 January 2011 (ie, 8488 women and 6182 men). We analysed all the chronic diseases registered in patients’ electronic health records until 31 December 2011.Primary outcomeWe performed an exploratory factor analysis to identify the multimorbidity patterns in men and women, and logistic and Cox proportional-hazards regressions to investigate the association between the patterns and the risk of hospitalisation in 2012, and of 3-year mortality.ResultsAlmost all HF patients (98%) had multimorbidity, with an average of 7.8 chronic diseases per patient. We identified six different multimorbidity patterns, named cardiovascular, neurovascular, coronary, metabolic, degenerative and respiratory. The most prevalent were the degenerative (64.0%) and cardiovascular (29.9%) patterns in women, and the metabolic (49.3%) and cardiovascular (43.2%) patterns in men. Every pattern was associated with higher hospitalisation risks; and the cardiovascular, neurovascular and respiratory patterns significantly increased the likelihood of 3-year mortality.ConclusionsMultimorbidity is the norm rather than the exception in patients with heart failure, whose comorbidities tend to cluster together beyond simple chance in the form of multimorbidity patterns that have different impact on health outcomes. This knowledge could be useful to better understand common pathophysiological pathways underlying this condition and its comorbidities, and the factors influencing the prognosis of men and women with HF. Further large scale longitudinal studies are encouraged to confirm the existence of these patterns as well as their differential impact on health outcomes.
Cubic spinel LiMn2O4 has been studied for the reversible extraction of Li+ from natural brine after the application of suitable electrode potentials. In this work we report on the ...insertion/extraction of Li+ from natural brine of Olaroz salt flat (Jujuy, Argentina) and aqueous LiCl solutions into/from Li1-xMn2O4 (0 < x ≤ 1) to determine changes in the crystal structure and surface composition upon electrochemical polarization. In agreement with the behavior in organic electrolytes, we found that the insertion and extraction of Li+ proceeds via a two stage process and that the crystal structure undergoes two cubic phase transitions as the lattice is expanded or contracted. Contrary to the behavior in organic solvents, no decomposition layer is formed on the electrode surface and the surface composition can be controlled with the electrode potential. We also found that sodium cations present in natural brine are not inserted into the crystal lattice in the potential window explored, however they are adsorbed on the oxide surface blocking Li+ adsorption sites and decreasing the rate of Li+ exchange.
In this study we first measured the mineralization of pyrene on leaves of urban holm oak (Quercus ilex) by autochthonous microorganisms and an inoculated PAH degrading bacterium (i.e., Mycobacterium ...gilvum), selected as a model phyllosphere species, as well as the leaf-water (KLW) and leaf-air (KLA) partition coefficients for this chemical. Mineralization was investigated in two different experimental systems in terms of leaf and microorganism environment. Additionally, the influence on pyrene partitioning and mineralization when particulate matter (PM) was present on the leaf surface or removed was studied. Mineralization of 14C-labeled pyrene by autochthonous microorganisms was lower than 1% after approximately two weeks, while M. gilvum mineralized 5% to 17% of pyrene. These extents corresponded to mineralization half-lives that ranged between ~30 to ~200 days. We proposed that PM present at the leaf surface reduced the accumulation of pyrene by inner compartments (cuticle) distantly located from microbial cells and enhanced the bioaccessibility of pyrene, speeding up microbial activity and therefore mineralization. These results highlight that plant-phyllosphere microorganism interaction is more complex than currently established and deserves additional studies to further comprehend the air purification ecosystem service of phyllosphere microorganisms.
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•Pyrene is mineralized by microorganisms on holm oak leaves.•Biodegradation half-lives for pyrene range between 13 and 80 days.•Particulate matter could enhance pyrene mineralization.•Leaf-microbe interaction contribute to air quality improvement.•Half-lives provided facilitate “air purification” ecosystem service predictions.
We sought to identify the comorbidities associated with heart failure (HF) in a non-selected cohort of patients, and its influence on mortality and rehospitalization.
Data were obtained from the ...'Registro de Insuficiencia Cardiaca' (RICA) of the Spanish Society of Internal Medicine. The registry includes patients prospectively admitted in Internal Medicine units for acute HF. Variables included in Charlson Index (ChI) were collected and analysed according to age, gender, left ventricular ejection fraction (LVEF) and Barthel Index. The primary end point of study was the likelihood of rehospitalization and death for any cause during the year after discharge.
We included 2051 patients, mean age 78 and 53% females. LVEF was ⩾ 50% in 59.1% of the cohort. There was a high degree of dependency as measured by Barthel Index (14.8 % had an index ≤ 60). Mean ChI was 2.91 (SD ± 2.4). The most frequent comorbidities included in ChI were diabetes mellitus (44.3%), chronic renal impairment (30.8%) and chronic obstructive pulmonary disease (COPD) (27.4%). Age, myocardial infarction, peripheral artery disease, dementia, COPD, chronic renal impairment and diabetes with target-organ damage were all identified as independent prognostic factors for the combined end point of rehospitalization and death at 1 year. However, if multivariate analysis was done including ChI, only this remained as an independent prognostic factor for the combined end point (P < 0.001).
HF is a comorbid condition. ChI is a simple and feasible tool for estimating the burden of comorbidities in such population. We believe that a holistic approach to HF would improve prognosis and the relief the pressure exerted on public health services.
Summary
We reviewed systematically sugammadex vs neostigmine for reversing neuromuscular blockade. We included 17 randomised controlled trials with 1553 participants. Sugammadex reduced all signs of ...residual postoperative paralysis, relative risk (95% CI) 0.46 (0.29–0.71), p = 0.0004 and minor respiratory events, relative risk (95% CI) 0.51 (0.32–0.80), p = 0.0034. There was no difference in critical respiratory events, relative risk (95% CI) 0.13 (0.02–1.06), p = 0.06. Sugammadex reduced drug‐related side‐effects, relative risk (95% CI) 0.72 (0.54–0.95), p = 0.02. There was no difference in the rate of postoperative nausea or the rate of postoperative vomiting, relative risk (95% CI) 0.94 (0.79–1.13), p = 0.53, and 0.87 (0.65–1.17), p = 0.36 respectively.
Urban trees provide important ecosystem services, including air quality improvement. Polycyclic aromatic hydrocarbons (PAHs) are among the most important pollutants in air, due to their elevated ...concentrations and toxicity. Plants can act as filters of PAHs and as “chemical reactors” for pollutant removal, therefore reducing air concentrations. Here, the first assessment of photo- vs. biodegradation of PAHs on leaves of urban trees is presented. A dynamic air-vegetation-soil model (SoilPlusVeg) was improved to simulate the fate of two representative PAHs with contrasting physico-chemical properties (phenanthrene and benzoapyrene). Simulations were performed for two different environmental scenarios from Italy (Como and Naples), selected for their dissimilar meteorological parameters, plant species and emission levels. The effect of photo- and biodegradation on leaf concentrations and fluxes towards air and soil was investigated comparing deciduous (maple, cornel and hazelnut) and evergreen (holm oak) broadleaf woods. The results showed that biodegradation in the phyllosphere could not be neglected when evaluating the ecosystem services provided by urban trees, as this process contributed significantly to the reductions (up to 25% on average) in PAH leaf concentrations and fluxes to air and soil; however, the reductions revealed ample variations with time (up to more than two orders of magnitude) showing the dependence on meteorological parameters, air compartment structure, as well as type of woods. These findings permitted to improve the ecological realism of the simulations and obtain more accurate results when predicting organic contaminant uptake and release by plant leaves, including potential for food chain transfer and long-range transport.
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•Organic contaminant photo- and biodegradation rates on plant leaves are poorly known•Photodegradation and phyllosphere bacteria do influence PAH half-life on leaf surface•SoilPlusVeg model allows to simulate the PAH removal from air by urban trees•PAH air-leaf fluxes increase up to 30% when biodegradation on leaves is considered•New degradation rates on leaves are needed to improve model predictions
▶ Bayesian Networks are usefully applied in the domain of traffic accident modeling. ▶ BNs are used for classifying traffic accidents according to their injury severity. ▶ BNs inference identifies ...variables associated with KSI (killed or seriously injured). ▶ The key variables for KSI were accident type, age, lighting and number of injuries.
Several different factors contribute to injury severity in traffic accidents, such as driver characteristics, highway characteristics, vehicle characteristics, accidents characteristics, and atmospheric factors. This paper shows the possibility of using Bayesian Networks (BNs) to classify traffic accidents according to their injury severity. BNs are capable of making predictions without the need for pre assumptions and are used to make graphic representations of complex systems with interrelated components. This paper presents an analysis of 1536 accidents on rural highways in Spain, where 18 variables representing the aforementioned contributing factors were used to build 3 different BNs that classified the severity of accidents into slightly injured and killed or severely injured. The variables that best identify the factors that are associated with a killed or seriously injured accident (accident type, driver age, lighting and number of injuries) were identified by inference.
Reactive oxygen species (ROS) are best known for being involved in cellular metabolism and oxidative stress, but also play important roles in cell communication. ROS signaling has become increasingly ...recognized as a mechanism implicated in the regulation of synaptic neurotransmission, under both physiological and pathological conditions. Hydrogen peroxide (H2O2) and superoxide anion are the main biologically relevant endogenous ROS in the nervous system. They are predominantly produced in the mitochondria of neurons and glial cells and their levels are tightly regulated by the antioxidant cell machinery, which allows for dynamic signaling through these agents. Physicochemical and biological properties of H2O2 enable it to effectively play an important role in signaling. This review brings up some or the most significant evidence supporting ROS as signaling agents in the nervous system and summarizes data showing that ROS modulate γ-aminobutyric acid (GABA)-mediated neurotransmission by pre- and postsynaptic mechanisms. ROS induce changes on both, the activity of phasic and tonic GABAA receptors and GABA release from presynaptic terminals. Based on these facts, ROS signaling is discussed as a possible selective mechanism linking cellular metabolism to inhibitory neurotransmission through the direct or indirect modulation of the GABAA receptor function.
This article is part of a Special Issue entitled: Honoring Ricardo Miledi - outstanding neuroscientist of XX-XXI centuries.
•Reactive oxygen species can act as signaling molecules in neurons and glial cells.•GABA-mediated inhibitory neurotransmission is regulated by reactive oxygen species.•Reactive oxygen species can produce functional changes on neuronal GABAA receptors.•GABA release from synaptic terminals is modulated by reactive oxygen species.
•Expansive grouts are develop to seal concrete cracks.•A method is proposed to evaluate the sealing ability of the fabricated grouts.•Crack sealing with expansive grouts allows high integration with ...the concrete element.•Physic-chemical interactions between sealing grout and concrete are detected.
The main objective of the work presented in this paper is to evaluate the effectiveness of using three inorganic expansive agents in developing expansive cementitious grouts for sealing concrete cracks. Two of the agents were ettringite-based (K and NK) and one was CaO-based (G). Nine expansive cement grouts and one non-expansive cement grout were developed, and their expansive and mechanical performance were characterized. Additionally, an original method based on the water penetration test is proposed to evaluate the sealing capability of the produced grouts which has demonstrated high feasibility in determining the sealing effectiveness of the cement grouts designed. After sealing the simulated cracks, a strong decrease (≈80%) of the water penetration was detected when using 5% in weight cements of G or NK agents. An important but lower decrease (≈50%) was detected by using 5% of K agent. Moreover, the results obtained in the Brazilian test indicated that sealing with expansive cement grouts allows a high integration of the sealing material within the surrounding concrete element, achieving good mechanical bonding, so the sealing material and concrete act as a compact sole material. BSEM-EDAX analyses also showed slight evidence of chemical interaction between the sealing expansive grout and the surrounding concrete when using NK agent, but strong evidence of physical interaction since the penetration of some kind of amorphous hydrates from the grout side to the concrete side was detected.
The fracture resistance of different advanced high-strength steel (AHSS) sheets for automotive applications is investigated through conventional tensile tests, fracture toughness measurements, and ...hole expansion tests. Different fracture-related parameters, such as the true fracture strain (TFS), the true thickness strain (TTS), the fracture toughness at crack initiation (
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), the specific essential work of fracture (
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), and the hole expansion ratio (HER), are assessed. The specific essential work of fracture (
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) is shown to be a suitable parameter to evaluate the local formability and fracture resistance of AHSS. The results reveal that fracture toughness cannot be estimated from any of the parameters derived from tensile tests and show the importance of microstructural features on crack propagation resistance. Based on the relation fracture toughness-local formability, a new AHSS classification mapping accounting for global formability and cracking resistance is proposed. Furthermore, a physically motivated fracture criterion for edge-cracking prediction, based on thickness strain measurements in fatigue pre-cracked DENT specimens, is proposed.
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