Kinematic Parameters That Can Discriminate in Levels of Functionality in the Six-Minute Walk Test in Patients with Heart Failure with a Preserved Ejection Fraction

It is a challenge to manage and assess heart failure with preserved left ventricular ejection fraction (HFpEF) patients. Six-Minute Walk Test (6MWT) is used in this clinical population as a functional test. The objective of the study was to assess gait and kinematic parameters in HFpEF patients during the 6MWT with an inertial sensor and to discriminate patients according to their performance in the 6MWT: (1) walk more or less than 300 m, (2) finish or stop the test, (3) women or men and (4) fallen or did not fall in the last year. A cross-sectional study was performed in patients with HFpEF older than 70 years. 6MWT was carried out in a closed corridor larger than 30 m. Two Shimmer3 inertial sensors were used in the chest and lumbar region. Pure kinematic parameters analysed were angular velocity and linear acceleration in the three axes. Using these data, an algorithm calculated gait kinematic parameters: total distance, lap time, gait speed and step and stride variables. Two analyses were done according to the performance. Student’s t-test measured differences between groups and receiver operating characteristic assessed discriminant ability. Seventy patients performed the 6MWT. Step time, step symmetry, stride time and stride symmetry in both analyses showed high AUC values (>0.75). More significant differences in velocity and acceleration in the maximum Y axis or vertical movements. Three pure kinematic parameters obtained good discriminant capacity (AUC > 0.75). The new methodology proved differences in gait and pure kinematic parameters that can distinguish two groups according to the performance in the 6MWT and they had discriminant capacity.This work was supported by the Spanish Foundation of Internal Medicine, through the call “Prof. Dr. Miguel Vilardell 2019 research project”, grant number: FEMI-PB-PI-MV-2019. Partial funding for open access charge: Universidad de Málaga

The climate of a retrograde rotating Earth

To enhance understanding of Earth's climate, numerical experiments are performed contrasting a retrograde and prograde rotating Earth using the Max Planck Institute Earth system model. The experiments show that the sense of rotation has relatively little impact on the globally and zonally averaged energy budgets but leads to large shifts in continental climates, patterns of precipitation, and regions of deep water formation.Changes in the zonal asymmetries of the continental climates are expected given ideas developed more than a hundred years ago. Unexpected was, however, the switch in the character of the European–African climate with that of the Americas, with a drying of the former and a greening of the latter. Also unexpected was a shift in the storm track activity from the oceans to the land in the Northern Hemisphere. The different patterns of storms and changes in the direction of the trades influence fresh water transport, which may underpin the change of the role of the North Atlantic and the Pacific in terms of deep water formation, overturning and northward oceanic heat transport. These changes greatly influence northern hemispheric climate and atmospheric heat transport by eddies in ways that appear energetically consistent with a southward shift of the zonally and annually averaged tropical rain bands. Differences between the zonally averaged energy budget and the rain band shifts leave the door open, however, for an important role for stationary eddies in determining the position of tropical rains. Changes in ocean biogeochemistry largely follow shifts in ocean circulation, but the emergence of a super oxygen minimum zone in the Indian Ocean is not expected. The upwelling of phosphate-enriched and nitrate-depleted water provokes a dominance of cyanobacteria over bulk phytoplankton over vast areas – a phenomenon not observed in the prograde model.What would the climate of Earth look like if it would rotate in the reversed (retrograde) direction? Which of the characteristic climate patterns in the ocean, atmosphere, or land that are observed in a present-day climate are the result of the direction of Earth's rotation? Is, for example, the structure of the oceanic meridional overturning circulation (MOC) a consequence of the interplay of basin location and rotation direction? In experiments with the Max Planck Institute Earth system model (MPI-ESM), we investigate the effects of a retrograde rotation in all aspects of the climate system.The expected consequences of a retrograde rotation are reversals of the zonal wind and ocean circulation patterns. These changes are associated with major shifts in the temperature and precipitation patterns. For example, the temperature gradient between Europe and eastern Siberia is reversed, and the Sahara greens, while large parts of the Americas become deserts. Interestingly, the Intertropical Convergence Zone (ITCZ) shifts southward and the modeled double ITCZ in the Pacific changes to a single ITCZ, a result of zonal asymmetries in the structure of the tropical circulation.One of the most prominent non-trivial effects of a retrograde rotation is a collapse of the Atlantic MOC, while a strong overturning cell emerges in the Pacific. This clearly shows that the position of the MOC is not controlled by the sizes of the basins or by mountain chains splitting the continents in unequal runoff basins but by the location of the basins relative to the dominant wind directions. As a consequence of the changes in the ocean circulation, a super oxygen minimum zone develops in the Indian Ocean leading to upwelling of phosphate-enriched and nitrate-depleted water. These conditions provoke a dominance of cyanobacteria over bulk phytoplankton over vast areas, a phenomenon not observed in the prograde model.</p

Large-scale magnetic fields from inflation due to a CPTCPT-even Chern-Simons-like term with Kalb-Ramond and scalar fields

We investigate the generation of large-scale magnetic fields due to the breaking of the conformal invariance in the electromagnetic field through the $CPT$-even dimension-six Chern-Simons-like effective interaction with a fermion current by taking account of the dynamical Kalb-Ramond and scalar fields in inflationary cosmology. It is explicitly demonstrated that the magnetic fields on 1Mpc scale with the field strength of $\sim 10^{-9}$G at the present time can be induced.Comment: 18 pages, 6 figures, version accepted for publication in Eur. Phys. J.

Relapse, cognitive reserve, and their relationship with cognition in first episode schizophrenia: a 3-year follow-up study

Schizophrenia is frequently characterized by the presence of multiple relapses. Cognitive impairments are core features of schizophrenia. Cognitive reserve (CR) is the ability of the brain to compensate for damage caused by pathologies such as psychotic illness. As cognition is related to CR, the study of the relationship between relapse, cognition and CR may broaden our understanding of the course of the disease. We aimed to determine whether relapse was associated with cognitive impairment, controlling for the effects of CR. Ninety-nine patients with a remitted first episode of schizophrenia or schizophreniform disorder were administered a set of neuropsychological tests to assess premorbid IQ, attention, processing speed, working memory, verbal and visual memory, executive functions and social cognition. They were followed up for 3 years (n=53) or until they relapsed (n=46). Personal and familial CR was estimated from a principal component analysis of the premorbid information gathered. Linear mixed-effects models were applied to analyse the effect of time and relapse on cognitive function, with CR as covariate. Patients who relapsed and had higher personal CR showed less deterioration in attention, whereas those with higher CR (personal and familial CR) who did not relapse showed better performance in processing speed and visual memory. Taken together, CR seems to ameliorate the negative effects of relapse on attention performance and shows a positive effect on processing speed and visual memory in those patients who did not relapse. Our results add evidence for the protective effect of CR over the course of the illness

Primitive Neuroectodermal Tumor (PNET) of the kidney: a case report

BACKGROUND: A case of Primitive Neuroectodermal Tumor (PNET) of the kidney in a 27-year-old woman is presented. Few cases are reported in the literature with a variable, nonspecific presentation and an aggressive behaviour. In our case, a radical nephrectomy with lymphadenectomy was performed and there was no residual or recurrent tumour at 24-month follow-up. METHODS: The surgical specimens were formalin-fixed and paraffin embedded. The sections were stained with routinary H&E. Immunohistochemistry was performed. RESULTS: The immunohistochemical evaluation revealed a diffuse CD99 positivity in the cytoplasm of the neoplastic cells. Pankeratin, cytokeratin AE1/AE3, vimentin, desmin, S100, cromogranin were negative. The clinical presentation and the macroscopic aspect, together with the histological pattern, the cytological characteristic and the cellular immunophenotype addressed the diagnosis towards primary PNET of kidney. CONCLUSIONS: Since sometimes it is difficult to discriminate between PNET and Ewing's tumour, we reviewed the difficulties in differential diagnosis. These tumors have a common precursor but the stage of differentiation in which it is blocked is probably different. This could also explain their different biological behaviour and prognosis

A longitudinal study of gene expression in first-episode schizophrenia; exploring relapse mechanisms by co-expression analysis in peripheral blood.

Little is known about the pathophysiological mechanisms of relapse in first-episode schizophrenia, which limits the study of potential biomarkers. To explore relapse mechanisms and identify potential biomarkers for relapse prediction, we analyzed gene expression in peripheral blood in a cohort of first-episode schizophrenia patients with less than 5 years of evolution who had been evaluated over a 3-year follow-up period. A total of 91 participants of the 2EPs project formed the sample for baseline gene expression analysis. Of these, 67 provided biological samples at follow-up (36 after 3 years and 31 at relapse). Gene expression was assessed using the Clariom S Human Array. Weighted gene co-expression network analysis was applied to identify modules of co-expressed genes and to analyze their preservation after 3 years of follow-up or at relapse. Among the 25 modules identified, one module was semi-conserved at relapse (DarkTurquoise) and was enriched with risk genes for schizophrenia, showing a dysregulation of the TCF4 gene network in the module. Two modules were semi-conserved both at relapse and after 3 years of follow-up (DarkRed and DarkGrey) and were found to be biologically associated with protein modification and protein location processes. Higher expression of DarkRed genes was associated with higher risk of suffering a relapse and early appearance of relapse (p = 0.045). Our findings suggest that a dysregulation of the TCF4 network could be an important step in the biological process that leads to relapse and suggest that genes related to the ubiquitin proteosome system could be potential biomarkers of relapse

Renal primitive neuroectodermal tumor: does age at diagnosis impact outcomes?

Primitive neuroectodermal tumor (PNET) of the kidney is a rare and highly malignant neoplasm. The median age for renal PNET is 27 years but it can be seen also in a wide age range between 3 and 78 years. We performed a Medline search for the term renal PNET and identified 79 cases up till December of 2010. We report here a new case of renal PNET and a literature review for published data for evaluation of clinicopathological prognostic factors, with an emphasis on prognosis in two groups of adults and children-adolescents: 18 years of age or under and over 18 years

Effectiveness of a gamified digital intervention based on lifestyle modification (iGAME) in secondary prevention: a protocol for a randomised controlled trial

Introduction Combating physical inactivity and reducing sitting time are one of the principal challenges proposed by public health systems. Gamification has been seen as an innovative, functional and motivating strategy to encourage patients to increase their physical activity (PA) and reduce sedentary lifestyles through behaviour change techniques (BCT). However, the effectiveness of these interventions is not usually studied before their use. The main objective of this study will be to analyse the effectiveness of a gamified mobile application (iGAME) developed in the context of promoting PA and reducing sitting time with the BCT approach, as an intervention of secondary prevention in sedentary patients.Methods and analysis A randomised clinical trial will be conducted among sedentary patients with one of these conditions: non-specific low back pain, cancer survivors and mild depression. The experimental group will receive a 12-week intervention based on a gamified mobile health application using BCT to promote PA and reduce sedentarism. Participants in the control group will be educated about the benefits of PA. The International Physical Activity Questionnaire will be considered the primary outcome. International Sedentary Assessment Tool, EuroQoL-5D, MEDRISK Instruments and consumption of Health System resources will be evaluated as secondary outcomes. Specific questionnaires will be administered depending on the clinical population. Outcomes will be assessed at baseline, at 6 weeks, at the end of the intervention (12 weeks), at 26 weeks and at 52 weeks.Ethics and dissemination The study has been approved by the Portal de Ética de la Investigación Biomédica de Andalucía Ethics Committee (RCT-iGAME 24092020). All participants will be informed about the purpose and content of the study and written informed consent will be completed. The results of this study will be published in a peer-reviewed journal and disseminated electronically and in print.Trial registration number NCT0401911