Ibero-American Society of Interventionism (SIDI) and the Spanish Society of Vascular and Interventional Radiology (SERVEI) Standard of Practice (SOP) for the Management of Inferior Vena Cava Filters in the Treatment of Acute Venous Thromboembolism

Vena cava filtersFiltres de vena cavaFiltros de vena cavaObjectives: to present an interventional radiology standard of practice on the use of inferior vena cava filters (IVCFs) in patients with or at risk to develop venous thromboembolism (VTE) from the Iberoamerican Interventional Society (SIDI) and Spanish Vascular and Interventional Radiology Society (SERVEI). Methods: a group of twenty-two interventional radiologist experts, from the SIDI and SERVEI societies, attended online meetings to develop a current clinical practice guideline on the proper indication for the placement and retrieval of IVCFs. A broad review was undertaken to determine the participation of interventional radiologists in the current guidelines and a consensus on inferior vena cava filters. Twenty-two experts from both societies worked on a common draft and received a questionnaire where they had to assess, for IVCF placement, the absolute, relative, and prophylactic indications. The experts voted on the different indications and reasoned their decision. Results: a total of two-hundred-thirty-three articles were reviewed. Interventional radiologists participated in the development of just two of the eight guidelines. The threshold for inclusion was 100% agreement. Three absolute and four relative indications for the IVCF placement were identified. No indications for the prophylactic filter placement reached the threshold. Conclusion: interventional radiologists are highly involved in the management of IVCFs but have limited participation in the development of multidisciplinary clinical practice guidelines

Machine learning-based model for prediction of clinical deterioration in hospitalized patients by COVID 19

[EN] Despite the publication of great number of tools to aid decisions in COVID-19 patients, there is a lack of good instruments to predict clinical deterioration. COVID19-Osakidetza is a prospective cohort study recruiting COVID-19 patients. We collected information from baseline to discharge on: sociodemographic characteristics, comorbidities and associated medications, vital signs, treatment received and lab test results. Outcome was need for intensive ventilatory support (with at least standard high-flow oxygen face mask with a reservoir bag for at least 6 h and need for more intensive therapy afterwards or Optiflow high-flow nasal cannula or noninvasive or invasive mechanical ventilation) and/or admission to a critical care unit and/or death during hospitalization. We developed a Catboost model summarizing the findings using Shapley Additive Explanations. Performance of the model was assessed using area under the receiver operating characteristic and prediction recall curves (AUROC and AUPRC respectively) and calibrated using the Hosmer-Lemeshow test. Overall, 1568 patients were included in the derivation cohort and 956 in the (external) validation cohort. The percentages of patients who reached the composite endpoint were 23.3% vs 20% respectively. The strongest predictors of clinical deterioration were arterial blood oxygen pressure, followed by age, levels of several markers of inflammation (procalcitonin, LDH, CRP) and alterations in blood count and coagulation. Some medications, namely, ATC AO2 (antiacids) and N05 (neuroleptics) were also among the group of main predictors, together with C03 (diuretics). In the validation set, the CatBoost AUROC was 0.79, AUPRC 0.21 and Hosmer-Lemeshow test statistic 0.36. We present a machine learning-based prediction model with excellent performance properties to implement in EHRs. Our main goal was to predict progression to a score of 5 or higher on the WHO Clinical Progression Scale before patients required mechanical ventilation. Future steps are to externally validate the model in other settings and in a cohort from a different period and to apply the algorithm in clinical practice. Registration: ClinicalTrials.gov Identifier: NCT04463706.This work was supported in part by grants from the Instituto de Salud Carlos III and the European Regional Development Fund COVID20/00459; the health outcomes group from Galdakao-Barrualde Health Organization; the Kronikgune Institute for Health Service Research; and the thematic network–REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas)–of the Instituto de Salud Carlos III. The funder of the study had no role in study design, data collection, analysis, management or interpretation, or writing of the report

Percutaneous implants of bone conduction: 8-year evolution and results

Background: Percutaneous bone conduction implants are an alternative to alleviate unilateral transmission, mixed and neurosensory hearing loss in patients unable to carry conventional hearing aids. Through this study we analyzed the indications of the osseointegrated systems in the Lozano Blesa Hospital (Zaragoza, Spain), among other aspects. Method: An observational study was carried out based on medical records, including patients who had been implanted with a percutaneous osseointegrated system since 2010. The collected data included demographic information, clinical and analytical data concerning his hearing loss and post-implant complications, among others. Results: 59 percutaneous implants were analyzed; 44.1% Baha type and 55.9% Ponto type. Regarding the audiological indication of the implant, mixed hearing loss was the most frequent cause (64,40%). The most frequent clinical diagnosis was chronic otitis media (83%). The functional hearing gain of the implanted patients due to transmission hearing loss was 26,92 ± 7,65 dB. The most used surgical technique was the U flap carried out in 42.40% patients. It has been observed a tendency between the relationship in the number of complications and the fact of performing a reduction of subcutaneous tissue surrounding the implant (p = 0,051). Discussion and conclusions: Although no significant differences were found, the demographic results, as well as the indication of implantation, functional gain and complications are similar to the data found in the medical literature. However, future studies with a larger number of patients would be convenient.Introducción: Los implantes de conducción de vía ósea percutáneos son una alternativa a los audífonos convencionales en hipoacusias de transmisión, mixtas y neurosensoriales unilaterales, en pacientes con imposibilidad de usar los primeros. Mediante este estudio analizamos diferentes aspectos de los sistemas osteointegrados en el Hospital Clínico Universitario Lozano Blesa de Zaragoza (España). Método: Se ha realizado un estudio observacional basado en historias clínicas, incluyendo a los pacientes que han sido implantados con un sistema osteointegrado de tipo percutáneo desde el año 2010. Entre los datos recogidos se valoraron datos demográficos, datos clínicos y analíticos referentes su hipoacusia y complicaciones post-implante entre otros. Resultados: Se han analizado 59 implantes percutáneos; un 44,1% tipo Baha y un 55,9 % tipo Ponto. La indicación audiológica mas frecuente fue la hipoacusia mixta (64,40%). El diagnóstico clínico más frecuente fue la otitis media crónica (83%). La ganancia auditiva funcional de los pacientes implantados debido a hipoacusia de transmisión fue de 26,92 ± 7,65 dB. La técnica quirúrgica más empleada fue el colgajo en U llevada a cabo en el 42,40% pacientes. Se ha objetivado cierta tendencia a la relación en el número de complicaciones y el hecho de realizar una reducción de tejido subcutáneo circundante al implante (p=0,051). Conclusiones: Aunque no se hayan encontrado diferencias significativas, los resultados tanto demográficos, como de indicación de la implantación, la ganancia funcional y las complicaciones son similares a los datos encontrados en la literatura médica

Peak systolic velocity at arterial Doppler ultrasound in pediatric liver transplantation: A predictor of acute severe complications

Pediatria; Ecografia Doppler; Velocitat sistòlica màximaPediatric; Doppler ultrasound; Peak systolic velocityPediatría; Ecografía Doppler; Velocidad sistólica máximaThe diagnosis of arterial complications in children after Liver Transplantation (LT) urges prompt diagnosis and treatment. This study aims to determine whether hepatic artery Doppler Ultrasound (DUS) parameters can predict arterial complications in the immediate period after LT in children. A retrospective review of the pediatric liver database at our tertiary-care pediatric hospital was performed. The study included 70 pediatric patients who underwent a liver transplantation from 2016 to 2021. Clinical, laboratory and Doppler findings were recorded daily the first 5 days after transplantation, with special attention given to post-anastomotic Peak Systolic Velocity (PSV) and Resistive Index (RI). Patients with hepatic artery complications, including acute thrombosis and stenosis, had lower PSV values after surgery compared to the group with non-complications, with a statistical significance (< 0.001). Receiver operating characteristic (ROC) curve analysis determined an optimal cut-off value of PSV less than 29 cm/s the 2nd day after LT, 25.2 cm/s the 3rd day, 28.5 cm/s the 4th day and 29.4 cm/s the 5th day, to discriminate children with and without hepatic arterial complications. Notably, these cut-off values are lower than those proposed in adults. Optimal PSV cutt-off values in children in the immediate period after LT are presented. Knowledge of these cutt-off values improves the interpretation of DUS measurements and thereby, may help to accurately guide the clinical management

Development of a Highly Selective Plasmodium falciparum Proteasome Inhibitor with Anti-malaria Activity in Humanized Mice.

Plasmodium falciparum proteasome (Pf20S) inhibitors are active against Plasmodium at multiple stages-erythrocytic, gametocyte, liver, and gamete activation stages-indicating that selective Pf20S inhibitors possess the potential to be therapeutic, prophylactic, and transmission-blocking antimalarials. Starting from a reported compound, we developed a noncovalent, macrocyclic peptide inhibitor of the malarial proteasome with high species selectivity and improved pharmacokinetic properties. The compound demonstrates specific, time-dependent inhibition of the β5 subunit of the Pf20S, kills artemisinin-sensitive and artemisinin-resistant P. falciparum isolates in vitro and reduces parasitemia in humanized, P. falciparum-infected mice

A potent antimalarial benzoxaborole targets a Plasmodium falciparum cleavage and polyadenylation specificity factor homologue.

Benzoxaboroles are effective against bacterial, fungal and protozoan pathogens. We report potent activity of the benzoxaborole AN3661 against Plasmodium falciparum laboratory-adapted strains (mean IC50 32 nM), Ugandan field isolates (mean ex vivo IC50 64 nM), and murine P. berghei and P. falciparum infections (day 4 ED90 0.34 and 0.57 mg kg-1, respectively). Multiple P. falciparum lines selected in vitro for resistance to AN3661 harboured point mutations in pfcpsf3, which encodes a homologue of mammalian cleavage and polyadenylation specificity factor subunit 3 (CPSF-73 or CPSF3). CRISPR-Cas9-mediated introduction of pfcpsf3 mutations into parental lines recapitulated AN3661 resistance. PfCPSF3 homology models placed these mutations in the active site, where AN3661 is predicted to bind. Transcripts for three trophozoite-expressed genes were lost in AN3661-treated trophozoites, which was not observed in parasites selected or engineered for AN3661 resistance. Our results identify the pre-mRNA processing factor PfCPSF3 as a promising antimalarial drug target

Herpesvirus Antibodies, Vitamin D and Short-Chain Fatty Acids: Their Correlation with Cell Subsets in Multiple Sclerosis Patients and Healthy Controls

Although the etiology of multiple sclerosis (MS) is still unknown, it is commonly accepted that environmental factors could contribute to the disease. The objective of this study was to analyze the humoral response to Epstein-Barr virus, human herpesvirus 6A/B and cytomegalovirus, and the levels of 25-hydroxyvitamin D (25(OH)D) and the three main short-chain fatty acids (SCFA), propionate (PA), butyrate (BA) and acetate (AA), in MS patients and healthy controls (HC) to understand how they could contribute to the pathogenesis of the disease. With this purpose, we analyzed the correlations among them and with different clinical variables and a wide panel of cell subsets. We found statistically significant differences for most of the environmental factors analyzed when we compared MS patients and HC, supporting their possible involvement in the disease. The strongest correlations with the clinical variables and the cell subsets analyzed were found for 25(OH)D and SCFAs levels. A correlation was also found between 25(OH)D and PA/AA ratio, and the interaction between these factors negatively correlated with interleukin 17 (IL-17)-producing CD4+ and CD8+ T cells in untreated MS patients. Therapies that simultaneously increase vitamin D levels and modify the proportion of SCFA could be evaluated in the future

Instituto de Biotecnología y Desarrollo Azul de la Universidad de Málaga: una apuesta por una Acuicultura Azul

Noventa investigadores de la Universidad de Málaga pertenecientes a 21 grupos de investigación, se han organizado en un Instituto de Biotecnología y Desarrollo Azul, IBYDA. El objetivo del IBYDA es la investigación, la docencia, el desarrollo y la transferencia de conocimiento en el marco del desarrollo circular o azul; incluyendo el análisis económico de los proyectos, el modelado de diferentes escenarios, y su aplicación a la gestión y planificación del territorio. Así mismo, el instituto ofrecerá infraestructuras acuícolas y servicios, y promoverá el emprendimiento. La actividad transversal central del IBYDA es la Acuicultura Multitrófica como implementación de la estrategia de Biorrefinería, es decir, el aprovechamiento de distintos tipos de residuos para el cultivo de organismos, cuya biomasa se empleará para la obtención de productos de alto valor añadido.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec