Perfil de pacientes hematológicos atendidos en un servicio de urgencias hospitalario

Poster [PC-355] Introducción: Durante los últimos años existe un aumento progresivo en la demanda de asistencia en los servicios de urgencias hospitalarios (SUH), tanto generales como pediátricos. Los pacientes hematológicos presentan numerosos episodios clínicos que precisan valoración clínica urgente y dada la facilidad de acceso a los SUH emplean este medio. Métodos: Estudio descriptivo observacional de las urgencias en pacientes con patología hematológica atendidas en el Servicio de Urgencias del Hospital Universitario Miguel Servet de Zaragoza (Hospital de tercer nivel). Periodo de estudio (Enero 2017-Diciembre 2017). Criterios de inclusión: Paciente: s con diagnóstico hematológico según la clasificación CIE-9 en el informe de alta de urgencias. Grupo de pacientes adultos (> 14 años): atendidos en el Hospital General, y grupo de pacientes pediátricos (< 14 años): atendidos en el Hospital Infantil. Variables analizadas: edad, sexo, grupo de patología y nivel de triaje. Datos recogidos a través del registro derivado de la Base de Datos generada por el aplicativo informático “Puesto Clínico Hospitalario de Urgencias”, que da soporte a la actividad asistencial de los servicios de urgencias hospitalarios de Aragón. Se obtuvo autorización correspondiente del centro y del SUH para el acceso a los datos informáticos. Resultados: Muestra total de 2193 pacientes: 1928 en el grupo de adultos y 265 en el grupo pediátrico. En el grupo de adultos la edad media de consulta en SUH fue de 71, 4 años (DE: 18.10), siendo el subgrupo de 81-90 años el que más frecuentemente acude (31.74%). En la población infantil la edad media de consulta fue de 6, 39 años (DE: 4.54), siendo entre los 0-2 años la edad que más frecuenta Urgencias (19.62%). Respecto a la distribución según sexo, el 55% de las consultas son realizadas por mujeres y el 45% por hombres. Sin embargo, en la población infantil el 52% de las consultas son realizadas por niños y el 48% por niñas. En el análisis según grupo de enfermedad: el grupo pediátrico consulta más frecuentemente por enfermedades de hemostasia (47.17%), mientras que los adultos consultan más por enfermedades de serie roja (61.28%). En ambos grupos, las consultas realizadas en Urgencias son de gran complejidad con una prioridad elevada de asistencia. El 93% de la patología en adultos y el 71% de la patología infantil hematológica es triada con niveles I-III de urgencia y tiempos asistenciales reducidos. Conclusiones: El comportamiento de las enfermedades hematológicas varía en función de la edad, el sexo y el tipo de enfermedad. La patología hematológica tiene un gran impacto dentro de los servicios de urgencias hospitalarios, dado que estos pacientes presentan un perfil complejo que requerirá diagnóstico y tratamiento rápido por la gravedad del tipo de complicaciones que asocian. En consonancia con la población envejecida, los pacientes que más demandan la atención en Urgencias y de forma repetida, son adultos muy mayores (81-90 años) pudiéndose plantear circuitos de asistencia urgente diferentes para estos pacientes

Differential regulation of mitochondrial pyruvate carrier genes modulates respiratory capacity and stress tolerance in yeast

Mpc proteins are highly conserved from yeast to humans and are necessary for the uptake of pyruvate at the inner mitochondrial membrane, which is used for leucine and valine biosynthesis and as a fuel for respiration. Our analysis of the yeast MPC gene family suggests that amino acid biosynthesis, respiration rate and oxidative stress tolerance are regulated by changes in the Mpc protein composition of the mitochondria. Mpc2 and Mpc3 are highly similar but functionally different: Mpc2 is most abundant under fermentative non stress conditions and important for amino acid biosynthesis, while Mpc3 is the most abundant family member upon salt stress or when high respiration rates are required. Accordingly, expression of the MPC3 gene is highly activated upon NaCl stress or during the transition from fermentation to respiration, both types of regulation depend on the Hog1 MAP kinase. Overexpression experiments show that gain of Mpc2 function leads to a severe respiration defect and ROS accumulation, while Mpc3 stimulates respiration and enhances tolerance to oxidative stress. Our results identify the regulated mitochondrial pyruvate uptake as an important determinant of respiration rate and stress resistance.This work was supported by Ministerio de Economia y Competitividad grant BFU2011-23326 to M.P.; A.T.-G. was supported by a JAE predoctoral grant from Consejo Superior de Investigaciones Cientificas. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Timón Gómez, A.; Proft ., MH.; Pascual-Ahuir Giner, MD. (2013). Differential regulation of mitochondrial pyruvate carrier genes modulates respiratory capacity and stress tolerance in yeast. PLoS ONE. 8(11):1-9. doi:10.1371/journal.pone.0079405S19811Murphy, M. P. (2008). How mitochondria produce reactive oxygen species. 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Ask yeast how to burn your fats: lessons learned from the metabolic adaptation to salt stress

[EN] Here, we review and update the recent advances in the metabolic control during the adaptive response of budding yeast to hyperosmotic and salt stress, which is one of the best understood signaling events at the molecular level. This environmental stress can be easily applied and hence has been exploited in the past to generate an impressively detailed and comprehensive model of cellular adaptation. It is clear now that this stress modulates a great number of different physiological functions of the cell, which altogether contribute to cellular survival and adaptation. Primary defense mechanisms are the massive induction of stress tolerance genes in the nucleus, the activation of cation transport at the plasma membrane, or the production and intracellular accumulation of osmolytes. At the same time and in a coordinated manner, the cell shuts down the expression of housekeeping genes, delays the progression of the cell cycle, inhibits genomic replication, and modulates translation efficiency to optimize the response and to avoid cellular damage. To this fascinating interplay of cellular functions directly regulated by the stress, we have to add yet another layer of control, which is physiologically relevant for stress tolerance. Salt stress induces an immediate metabolic readjustment, which includes the up-regulation of peroxisomal biomass and activity in a coordinated manner with the reinforcement of mitochondrial respiratory metabolism. Our recent findings are consistent with a model, where salt stress triggers a metabolic shift from fermentation to respiration fueled by the enhanced peroxisomal oxidation of fatty acids. We discuss here the regulatory details of this stress-induced metabolic shift and its possible roles in the context of the previously known adaptive functions.The work of the authors was supported by grants from Ministerio de Economía y Competitividad (BFU2011- 23326 and BFU2016-75792-R).Pascual-Ahuir Giner, MD.; Manzanares-Estreder, S.; Timón Gómez, A.; Proft ., MH. (2017). Ask yeast how to burn your fats: lessons learned from the metabolic adaptation to salt stress. Current Genetics. 64(1):63-69. https://doi.org/10.1007/s00294-017-0724-5S6369641Aguilera J, Prieto JA (2001) The Saccharomyces cerevisiae aldose reductase is implied in the metabolism of methylglyoxal in response to stress conditions. Curr Genet 39:273–283Albertyn J, Hohmann S, Thevelein JM, Prior BA (1994) GPD1, which encodes glycerol-3-phosphate dehydrogenase, is essential for growth under osmotic stress in Saccharomyces cerevisiae, and its expression is regulated by the high-osmolarity glycerol response pathway. 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J Biol Chem 288:17384–17398Rep M, Krantz M, Thevelein JM, Hohmann S (2000) The transcriptional response of Saccharomyces cerevisiae to osmotic shock. Hot1p and Msn2p/Msn4p are required for the induction of subsets of high osmolarity glycerol pathway-dependent genes. J Biol Chem 275:8290–8300Rep M, Proft M, Remize F, Tamas M, Serrano R, Thevelein JM, Hohmann S (2001) The Saccharomyces cerevisiae Sko1p transcription factor mediates HOG pathway-dependent osmotic regulation of a set of genes encoding enzymes implicated in protection from oxidative damage. Mol Microbiol 40:1067–1083Rienzo A, Poveda-Huertes D, Aydin S, Buchler NE, Pascual-Ahuir A, Proft M (2015) Different mechanisms confer gradual control and memory at nutrient- and stress-regulated genes in yeast. Mol Cell Biol 35:3669–3683Romero-Santacreu L, Moreno J, Perez-Ortin JE, Alepuz P (2009) Specific and global regulation of mRNA stability during osmotic stress in Saccharomyces cerevisiae. 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Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Effect of dibutyl itaconate on plasticization efficiency of a REX processed polylactide with peroxides

This work reports the effect of a reactive extrusion (REX) process on polylactide (PLA) based formulations plasticized with dibutyl itaconate (DBI). As DBI contains a carbon-carbon double bond, it is suitable for reactive extrusion. REX was carried out in a co-rotating twin extruder with the addition of two different organic peroxides. The main aim of using REX during the blending of the DBI plasticizer with PLA is to improve the interaction between them so the obtained final properties of the formulations could be improved. Plasticization process allowed to improve the ductile properties of PLA, by using REX, an improvement on the tensile strength was obtained with a no remarkable change in ductility. The thermal characterization also revealed that the glass transition temperature Tg was reduced for all formulations including DBI. REX with DBI provided a slight increase in Tg and this effect was also evident in thermomechanical properties. Regarding the thermal degradation behaviour, the plasticizer reduced the onset degradation and the maximum degradation rate, while a slight improvement on thermal stability was observed by using REX with organic peroxides. Finally, plasticizer migration in water was observed in conventional extruded PLA/DBI formulations, while REX provided improved behaviour against migration