Pretreatment of urine samples with SDS improves direct identification of urinary tract pathogens with matrix-assisted laser desorption ionization-time of flight mass spectrometry

[EN]We pretreated with SDS 71 urine samples with bacterial counts of >10(5) CFU/ml and matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) identification scores of <2, in order to minimize failure rates. Identification improved in 46.5% of samples, remained unchanged in 49.3%, and worsened in 4.2%. The improvement was more evident for Gram-negative (54.3%) than for Gram-positive (32%) bacteria

Intensive care unit discharge to the ward with a tracheostomy cannula as a risk factor for mortality: A prospective, multicenter propensity analysis

To analyze the impact of decannulation before intensive care unit discharge on ward survival in nonexperimental conditions. DESIGN: Prospective, observational survey. SETTING: Thirty-one intensive care units throughout Spain. PATIENTS: All patients admitted from March 1, 2008 to May 31, 2008. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: At intensive care unit discharge, we recorded demographic variables, severity score, and intensive care unit treatments, with special attention to tracheostomy. After intensive care unit discharge, we recorded intensive care unit readmission and hospital survival. STATISTICS: Multivariate analyses for ward mortality, with Cox proportional hazard ratio adjusted for propensity score for intensive care unit decannulation. We included 4,132 patients, 1,996 of whom needed mechanical ventilation. Of these, 260 (13%) were tracheostomized and 59 (23%) died in the intensive care unit. Of the 201 intensive care unit tracheostomized survivors, 60 were decannulated in the intensive care unit and 141 were discharged to the ward with cannulae in place. Variables associated with intensive care unit decannulation (non-neurologic disease [85% vs. 64%], vasoactive drugs [90% vs. 76%], parenteral nutrition [55% vs. 33%], acute renal failure [37% vs. 23%], and good prognosis at intensive care unit discharge [40% vs. 18%]) were included in a propensity score model for decannulation. Crude ward mortality was similar in decannulated and nondecannulated patients (22% vs. 23%); however, after adjustment for the propensity score and Sabadell Score, the presence of a tracheostomy cannula was not associated with any survival disadvantage with an odds ratio of 0.6 [0.3-1.2] (p=.1). CONCLUSION: In our multicenter setting, intensive care unit discharge before decannulation is not a risk factor

Late gadolinium enhancement distribution patterns in non-ischemic dilated cardiomyopathy: Genotype-phenotype correlation.

AIMS Late gadolinium enhancement (LGE) is frequently found in patients with dilated cardiomyopathy (DCM), there is little information about its frequency and distribution pattern according to underlying genetic substrate. We sought to describe LGE patterns according to genotype and to analyze the risk of major ventricular arrhythmias (MVA) according to patterns. METHODS AND RESULTS Cardiac magnetic resonance findings and LGE distribution according to genetics was performed in a cohort of 600 DCM patients followed at 20 Spanish centers. After exclusion of individuals with multiple causative gene variants or with variants in infrequent DCM-causing genes, 577 patients (34% females, mean age 53.5 years, LVEF 36.9 ± 13.9%) conformed the final cohort. A causative genetic variant was identified in 219 (38%) patients and 147 (25.5%) had LGE. Significant differences were found comparing LGE patterns between genes (P < 0.001). LGE was absent or rare in patients with variants in TNNT2, RBM20 and MYH7 (0%, 5% and 20%, respectively). Patients with variants in DMD, DSP and FLNC showed predominance of LGE subepicardial pattern (50%, 41% and 18%, respectively) whereas patients with variants in TTN, BAG3, LMNA and MYBPC3 showed unspecific LGE patterns. Genetic yield differed according to LGE pattern. Patients with subepicardial, lineal midwall, transmural, right ventricular insertion points or with combination of LGE patterns showed increased risk of MVA compared with patients without LGE. CONCLUSION LGE patterns in DCM has a specific distribution according to the affected gene. Certain LGE patterns are associated with increased risk of MVA and with increased yield of genetic testing.This study has been funded by Instituto Salud Carlos III (ISCIII) through the projects ‘PI18/0004, PI19/01283, and PI20/0320’ (co-funded by the European Regional Development Fund/European Social Fund ‘A way to make Europe’/‘Investing in your future’). The Hospital Universitario Puerta de Hierro, the Hospital Universitario Vall Hebrón, the Hospital General Universitario Gregorio Marañón, and the Hospital Universitario Virgen de la Arrixaca are members of the European Reference Network for Rare, Low Prevalence, and Complex Diseases of the Heart (ERN GUARD-Heart). F.d.F. receives grant support from ISCIII (CM20/00101). R.B. receives funding from the Obra Social la Caixa Foundation. M.B. receives funding from ISCIII (PI19/01283). The CNIC is supported by the ISCIII, Ministerio de Ciencia e Innovación of the Spanish Government (MCIN), and Pro CNIC Foundation.S

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Ferroelectric and Piezoelectric Characterization of Porous (K, Na, Li)(Nb, Ta, Sb)O₃

Polvo de KNL-NTS con estequiometria (K0.44Na0.52Li0.04)(Nb0.86Ta0.10Sb0.04)O3 fue preparado siguiendo el método convencional cerámico de mezcla de carbonatos y óxidos. La síntesis del polvo de KNL-NTS fue llevada a cabo en estado sólido a 700 ºC durante 3h. Para obtener muestras cerámicas con diferente porosidad, se llevó a cabo la sinterización de pastillas en un rango de temperaturas entre 1088 y 1125 ºC durante 2h en aire. Las muestras fueron caracterizadas estructural y microestructuralmente mediante DRX y MEB, y se determinó el grado y tipo de porosidad mediante porosimetría de intrusión de mercurio. Se investigó la influencia de la temperatura de sinterización en la porosidad y se evaluó el impacto de la misma en los ciclos de histéresis ferroeléctricos y la respuesta piezoeléctrica de las pastillas. La máxima densificación del material se consigue a 1125 ºC y la mejor respuesta ferroeléctrica, en pastillas sinterizadas a 1112 ºC. Por su parte, se observó que pastillas fabricadas en un rango de temperaturas inferior (1094-1100 ºC) donde la porosidad alcanza valores de hasta 15 % presentan buena respuesta piezo-ferroeléctrica, similar a la encontrada en las pastillas sinterizadas a 1125 ºC.KNL-NTS powder with (K0.44Na0.52Li0.04)(Nb0.86Ta0.10Sb0.04)O3 stoichiometry was prepared following the conventional ceramic method of mixing carbonates and oxides. KNL-NTS powder synthesis is carried out in solid state at 700°C for 3h. To obtain ceramic samples with different porosity the sintering of pellets is carried out in air at different temperatures between 1088 and 1125°C for 2h. Structural and microstructural characterizations are performed by XRD and SEM and the degree and type of porosity is determined by mercury intrusion porosimetry. The influence of sintering temperature on the porosity and its consequence on both the ferroelectric hysteresis loops and the piezoelectric response was evaluated. The maximum densification is achieved at 1125°C and the best ferroelectric response is achieved in sintered pellets at 1125°C. Meanwhile, it was observed that pellets sintered in a lower temperature range (1094-1100°C) where porosity reaches values up to 15 % have good ferroelectric piezoelectric response, similar to that found in the sintered pellets to 1125°C.Facultad de Ciencias Exacta

Ferroelectric and Piezoelectric Characterization of Porous (K, Na, Li)(Nb, Ta, Sb)O₃

Polvo de KNL-NTS con estequiometria (K0.44Na0.52Li0.04)(Nb0.86Ta0.10Sb0.04)O3 fue preparado siguiendo el método convencional cerámico de mezcla de carbonatos y óxidos. La síntesis del polvo de KNL-NTS fue llevada a cabo en estado sólido a 700 ºC durante 3h. Para obtener muestras cerámicas con diferente porosidad, se llevó a cabo la sinterización de pastillas en un rango de temperaturas entre 1088 y 1125 ºC durante 2h en aire. Las muestras fueron caracterizadas estructural y microestructuralmente mediante DRX y MEB, y se determinó el grado y tipo de porosidad mediante porosimetría de intrusión de mercurio. Se investigó la influencia de la temperatura de sinterización en la porosidad y se evaluó el impacto de la misma en los ciclos de histéresis ferroeléctricos y la respuesta piezoeléctrica de las pastillas. La máxima densificación del material se consigue a 1125 ºC y la mejor respuesta ferroeléctrica, en pastillas sinterizadas a 1112 ºC. Por su parte, se observó que pastillas fabricadas en un rango de temperaturas inferior (1094-1100 ºC) donde la porosidad alcanza valores de hasta 15 % presentan buena respuesta piezo-ferroeléctrica, similar a la encontrada en las pastillas sinterizadas a 1125 ºC.KNL-NTS powder with (K0.44Na0.52Li0.04)(Nb0.86Ta0.10Sb0.04)O3 stoichiometry was prepared following the conventional ceramic method of mixing carbonates and oxides. KNL-NTS powder synthesis is carried out in solid state at 700°C for 3h. To obtain ceramic samples with different porosity the sintering of pellets is carried out in air at different temperatures between 1088 and 1125°C for 2h. Structural and microstructural characterizations are performed by XRD and SEM and the degree and type of porosity is determined by mercury intrusion porosimetry. The influence of sintering temperature on the porosity and its consequence on both the ferroelectric hysteresis loops and the piezoelectric response was evaluated. The maximum densification is achieved at 1125°C and the best ferroelectric response is achieved in sintered pellets at 1125°C. Meanwhile, it was observed that pellets sintered in a lower temperature range (1094-1100°C) where porosity reaches values up to 15 % have good ferroelectric piezoelectric response, similar to that found in the sintered pellets to 1125°C.Facultad de Ciencias Exacta

Ferroelectric and Piezoelectric Characterization of Porous (K, Na, Li)(Nb, Ta, Sb)O₃

Polvo de KNL-NTS con estequiometria (K0.44Na0.52Li0.04)(Nb0.86Ta0.10Sb0.04)O3 fue preparado siguiendo el método convencional cerámico de mezcla de carbonatos y óxidos. La síntesis del polvo de KNL-NTS fue llevada a cabo en estado sólido a 700 ºC durante 3h. Para obtener muestras cerámicas con diferente porosidad, se llevó a cabo la sinterización de pastillas en un rango de temperaturas entre 1088 y 1125 ºC durante 2h en aire. Las muestras fueron caracterizadas estructural y microestructuralmente mediante DRX y MEB, y se determinó el grado y tipo de porosidad mediante porosimetría de intrusión de mercurio. Se investigó la influencia de la temperatura de sinterización en la porosidad y se evaluó el impacto de la misma en los ciclos de histéresis ferroeléctricos y la respuesta piezoeléctrica de las pastillas. La máxima densificación del material se consigue a 1125 ºC y la mejor respuesta ferroeléctrica, en pastillas sinterizadas a 1112 ºC. Por su parte, se observó que pastillas fabricadas en un rango de temperaturas inferior (1094-1100 ºC) donde la porosidad alcanza valores de hasta 15 % presentan buena respuesta piezo-ferroeléctrica, similar a la encontrada en las pastillas sinterizadas a 1125 ºC.KNL-NTS powder with (K0.44Na0.52Li0.04)(Nb0.86Ta0.10Sb0.04)O3 stoichiometry was prepared following the conventional ceramic method of mixing carbonates and oxides. KNL-NTS powder synthesis is carried out in solid state at 700°C for 3h. To obtain ceramic samples with different porosity the sintering of pellets is carried out in air at different temperatures between 1088 and 1125°C for 2h. Structural and microstructural characterizations are performed by XRD and SEM and the degree and type of porosity is determined by mercury intrusion porosimetry. The influence of sintering temperature on the porosity and its consequence on both the ferroelectric hysteresis loops and the piezoelectric response was evaluated. The maximum densification is achieved at 1125°C and the best ferroelectric response is achieved in sintered pellets at 1125°C. Meanwhile, it was observed that pellets sintered in a lower temperature range (1094-1100°C) where porosity reaches values up to 15 % have good ferroelectric piezoelectric response, similar to that found in the sintered pellets to 1125°C.Facultad de Ciencias Exacta