Solvent-cast direct-writing as a fabrication strategy for radiopaque stents

Bioresorbable stents (BRS) potential in treating coronary heart disease is still to be further developed. Current trends include research with new polymeric materials, the need for thinner struts combined with appropriate mechanical properties, radiopacity and optimized local drug delivery. This work presents a novel solvent-cast direct-write (SC-DW) printing system to manufacture BRS onto a rotating cylinder with poly-l-lactic acid (PLLA) and poly(l-lactic-co- ¿ -caprolactone) (PLCL) inks. Printed stents were characterized in terms of mechanical, thermal and biological properties with human umbilical vein endothelial cells (HUVECs). Expansion assays showed that stents withstood pressures of at least 16 atm and the indirect cytotoxicity test indicated that stents were biocompatible. Polymeric inks were further modified with the addition of 3 radiopaque agents, namely iodine, triiodobenzoic acid (TIBA) and barium sulfate (BaSO) to render stents radiopaque. Subsequent characterization showed a general increase in strut thickness with respect to control PLLA or PLCL stents, which in turn resulted in higher resistance to compression. Microcomputed tomography was used to assess stents’ radiopacity, showing that TIBA and BaSO-containing stents presented high X-ray attenuation values and maintained their radiopacity after 3 months incubation time.Peer ReviewedPostprint (published version

Prehospital emergency care of patients with acute heart failure in Spain: the SEMICA study (Emergency Medical Response Systems for Patients with Acute Heart Failure)

Objectives. To study the means of emergency transport used to bring patients with acute heart failure (AHF) to hospital emergency departments (EDs) and explore associations between factors, type of transport, and prehospital care received. Methods. We gathered the following information on patients treated for AHF at 34 Spanish hospital EDs: means of transport used (medicalized ambulance [MA], nonmedicalized ambulance [NMA], or private vehicle) and treatments administered before arrival at the hospital. Twenty-seven independent variables potentially related to type of transport used were also studied. Indicators of AHF severity were triage level assigned in the ED, need for admission, need for intensive care, in-hospital mortality, and 30-day mortality. Results. A total of 6106 patients with a mean (SD) age of 80 years were included; 56.5% were women, 47.2% arrived in PVs, 37.8% in NMAs, and 15.0% in MAs. Use of an ambulance was associated with female sex, age over 80 years, chronic obstructive pulmonary disease, a history of AHF, functional dependency, New York Heart Association class III-IV, sphincteral incontinence, labored breathing, orthopnea, cold skin, and sensory depression or restlessness. Assignment of a MA was directly associated with living alone, a history of ischemic heart disease, cold skin, sensory depression or restlessness, and high temperature; it was inversely associated with a history of falls. The rates of receipt of prehospital treatments and AHF severity level increased with use of MAs vs. NMAs vs. PV. Seventy-three percent of patients transported in MAs received oxygen, 29% received a diuretic, 13.5% a vasodilator, and 4.7% noninvasive ventilation. Conclusions. Characteristics of the patient with AHF are associated with the assignment of type of transport to a hospital ED. Assignment appears to be related to severity. Treatment given during MA transport could be increased

Química de las bebidas autocalentables

Se muestra la termodinámica y química implicadas en el proceso de calentamiento de las bebidas comerciales conocidas como "autocalentables", así como sus implicaciones didácticas

IMPROV-ED study : outcomes after discharge for an episode of acute-decompensated heart failure and comparison between patients discharged from the emergency department and hospital wards

Objective To define the short-and mid-term outcomes of patients discharged after an episode of acute-decompensated heart failure (ADHF) and evaluate the differences between patients discharged directly from the emergency department (ED) and those discharged after hospitalization. Methods We performed a prospective, multicenter, cohort-designed study, including consecutive patients diagnosed with ADHF in 27 Spanish EDs. Thirty-four variables on epidemiology, comorbidity, baseline status, vital signs, signs of congestion, laboratory tests, and treatment were collected in every patient. The primary outcome was a combined endpoint of ED revisit (without hospitalization) or hospitalization due to ADHF, or all-cause death. Secondary outcomes were each of these three events individually. Outcomes were obtained by survival analysis at different timepoints in the entire cohort, and crude and adjusted comparisons were carried out between patients discharged directly from the ED and after hospitalization. Results Of the 3233 patients diagnosed with ADHF during a 2-month period, we analyzed 2986 patients discharged alive: 787 (26.4%) discharged from the ED and 2199 (73.6%) after hospitalization. The cumulative percentages of events for the whole cohort (at 7/30/180 days) for the combined endpoint were 7.8/24.7/57.8; for ED revisit 2.5/9.4/25.5; for hospitalization 4.6/15.3/40.7; and for death 0.9/4.3/16.8. After adjustment for patient profile and center, significant increases were found in the hazard ratios for ED-compared to hospital-discharged patients in the combined endpoint, ED revisit and hospitalization, being higher at short-term [at 7 days, 2.373 (1.678-3.355), 2.069 (1.188-3.602), and 3.071 (1.915-4.922), respectively] than at mid-term [at 180 days, 1.368 (1.160-1.614), 1.642 (1.265-2.132), and 1.302 (1.044-1.623), respectively]. No significant differences were found in death. Conclusions Patients with ADHF discharged from the ED have worse outcomes, especially at short term, than those discharged after hospitalization. The definition and implementation of effective strategies to improve patient selection for direct ED discharge are needed.Peer reviewe

Evaluation of objective vitritis grading method using optical coherence tomography: influence of phakic status and previous vitrectomy

PURPOSE: To evaluate a proposed method for objective measurement of vitreous inflammation using a spectral. domain optical coherence tomography (SD OCT) device in a large cohort of uveitis eyes, including pseudophakic eyes and vitrectomized eyes. DESIGN: Retrospective, observational cohort study. METHODS: One hundred five uveitis eyes (105 patients) with different vitreous haze score grades according to standardized protocols and corresponding SD OCT images (Cirrus HD-OCT; Carl Zeiss Meditec, Dublin, California, USA) were included. Clinical data recorded included phakic status, previous vitreoretinal surgery, and anterior chamber (AC) cells and flare. SD OCT images were analyzed using custom software that provided absolute measurements of vitreous (VIT) and retinal pigment epithelium (RPE) signal intensities, which were compared to generate a relative optical density ratio with arbitrary units (VIT/RPE-relative intensity) and compared to VHS. RESULTS: VIT/RPE-relative intensity showed a significant positive correlation with vitreous haze score (r = 0.535, P <.001) that remained significant after adjusting for factors governing media clarity, such as AC cells, AC flare, and phakic status (R-2-adjusted = 0.424, P <.001). Significant differences were also observed between the different vitreous haze score groups (P <.001). Preliminary observation did not observe differences in VIT/RPE-relative intensity values between phakic and pseudophakic eyes (0.3522 vs 0.3577, P =.48) and between nonvitrectomized and vitrectomized eyes (0.3540 vs 0.3580, P = .52), overall and respectively for each vitreous haze score subgroup. CONCLUSIONS: VIT/RPE-relative intensity values provide objective measurements of vitreous inflammation employing an SD OCT device. Phakic status and previous vitrectomy su

Morphine Use in the ED and Outcomes of Patients With Acute Heart Failure A Propensity Score-Matching Analysis Based on the EAHFE Registry

OBJECTIVE: The objective was to determine the relationship between short-term mortality and intravenous morphine use in ED patients who received a diagnosis of acute heart failure (AHF). METHODS: Consecutive patients with AHF presenting to 34 Spanish EDs from 2011 to 2014 were eligible for inclusion. The subjects were divided into those with (M) or without IV morphine treatment (WOM) groups during ED stay. The primary outcome was 30-day all-cause mortality, and secondary outcomes were mortality at different intermediate time points, in-hospital mortality, and length of hospital stay. We generated a propensity score to match the M and WOM groups that were 1:1 according to 46 different epidemiological, baseline, clinical, and therapeutic factors. We investigated independent risk factors for 30-day mortality in patients receiving morphine. RESULTS: We included 6,516 patients (mean age, 81 [SD, 10] years; 56% women): 416 (6.4%) in the M and 6,100 (93.6%) in the WOM group. Overall, 635 (9.7%; M, 26.7%; WOM, 8.6%) died by day 30. After propensity score matching, 275 paired patients constituted each group. Patients receiving morphine had a higher 30-day mortality (55 [20.0%] vs 35 [12.7%] deaths; hazard ratio, 1.66; 95% CI, 1.09-2.54; P=.017). In patients receiving morphine, death was directly related to glycemia (P=.013) and inversely related to the baseline Barthel index and systolic BP (P=.021) at ED arrival (P=.021). Mortality was increased at every intermediate time point, although the greatest risk was at the shortest time (at 3 days: 22 [8.0%] vs 7 [2.5%] deaths; OR, 3.33; 95% CI, 1.40-7.93; P=.014). In-hospital mortality did not increase (39 [14.2%] vs 26 [9.1%] deaths; OR, 1.65; 95% CI, 0.97-2.82; P=.083) and LOS did not differ between groups (median [interquartile range] in M, 8 [7]; WOM, 8 [6]; P=.79). CONCLUSIONS: This propensity score-matched analysis suggests that the use of IV morphine in AHF could be associated with increased 30-day mortality.Peer reviewe

Quantification of Callose Deposition in Plant Leaves

Callose is an amorphous homopolymer, composed of β-1, 3-glucan, which is widespread in higher plants. Callose is involved in multiple aspects of plant growth and development. It is synthetized in plants at the cell plate during cytokinesis, in several stages during pollen development and is deposited at plasmodesmata to regulate the cell-to-cell movement of molecules. Moreover, it is produced in response to multiple biotic and abiotic stresses (Chen and Kim, 2009). Callose is considered to act as a physical barrier by strengthening the plant cell well to slow pathogen infection and to contribute to the plant’s innate immunity. Thus the callose staining method is useful to quantify activity of plant immunity. In addition, this staining can be used to visualize structures in plant tissue, where the callose may be implied whether during the development of plants or response against pathogen infection. This method is based on the use of methyl blue which reacts with (13)--glucans to give a brilliant yellow fluorescence in UV light. Moreover, calcofluor stains chitin present in fungal cell membranes and also binds to cellulose at locations where the cuticle is damaged.Authors thank Universitat Jaume I and the National R&D Plan (AGL2010-22300-C03-02, Spain for funding support

On-road vehicle emissions beyond RDE conditions

Passenger cars are an important source of air pollution, especially in urban areas. Recently, real-driving emissions (RDE) test procedures have been introduced in the EU aiming to evaluate nitrogen oxides (NOx) and particulate number (PN) emissions from passenger cars during on-road operation. Although RDE accounts for a large variety of real-world driving, it excludes certain driving situations by setting boundary conditions (e.g., in relation to altitude, temperature or dynamic driving). The present work investigates the on-road emissions of NOx, NO2, CO, particle number (PN) and CO2 from a fleet of nineteen Euro 6b, 6c and 6d-TEMP vehicles, including diesel, gasoline (GDI and PFI) and compressed natural gas (CNG) vehicles. The vehicles were tested under different on-road driving conditions outside boundaries. These included ‘baseline’ tests, but also testing conditions beyond the RDE boundary conditions to investigate the performance of the emissions control devices in demanding situations. Consistently, low average emission rates of PN and CO were measured from all diesel vehicles tested under most conditions. Moreover, the tested Euro 6d-TEMP and Euro 6c diesel vehicles met the NOx emission limits applicable to Euro 6d-TEMP diesel vehicles during RDE tests (168 mg/km). The Euro 6b GDI vehicle equipped with a gasoline particulate filter (GPF) presented PN emissions < 6×1011 #/km. These results, in contrast with previous on-road measurements from earlier Euro 6 vehicles, indicate more efficient emission control technologies are currently being used in diesel and gasoline vehicles. However, the results described in this report also raise some new concerns. In particular, the emissions of CO (measured during the regulated RDE test, but without an emission limit associated to it) or PN from PFI vehicles (presently not covered by the Euro 6 standard) showed elevated results in some occasions. Emissions of CO were up to 7.5 times higher when the more dynamic tests were conducted and the highest PN emissions were measured from a PFI gasoline vehicle during dynamic driving. The work also investigates how NOx, CO, PN and CO2 on-road emissions from three vehicles are impacted by sub-zero ambient temperatures and high altitudes. Two of the tested vehicles were Euro 6d-TEMP certified vehicles, one diesel and one gasoline, and one was a Euro 6b plug-in hybrid vehicle. The vehicles were studied during tests that do not fulfil the boundary conditions in terms of maximum altitude, altitude gain, and/or minimum temperature. The obtained emissions were compared to those obtained during tests performed along RDE routes. The results indicate that cold ambient temperature and high altitude, outside the RDE boundary conditions, lead to in higher NOx, CO and PN emissions compared to moderate conditions of temperature and altitude. Nonetheless, the two Euro 6d-TEMP vehicles tested in those extreme conditions yielded NOx emissions factors that fulfilled the Euro 6d-TEMP emission requirements. Our work underlines the importance of a technology- and fuel-neutral approach to vehicle emission standards, whereby all vehicles must comply with the same emission limits for all pollutants.JRC.C.4-Sustainable Transpor

Pronóstico de la insuficiencia cardíaca aguda basado en datos clínicos de congestión

Antecedentes y objetivos: Evaluar si los síntomas/signos de congestión en pacientes con insuficiencia cardíaca aguda (ICA) atendidos en los servicios de urgencias hospitalarios (SUH) permiten predecir la evolución a corto plazo. Pacientes y métodos: Pacientes consecutivos diagnosticados de ICA en 45 SUH del registro EAHFE. Recogimos variables clínicas de congestión sistémica (edemas en miembros inferiores, ingurgitación yugular, hepatomegalia) y pulmonar (disnea de esfuerzo, disnea paroxística nocturna, ortopnea y crepitantes pulmonares) analizando su asociación con la mortalidad por cualquier causa a 30 días, de forma cruda y ajustada por diferencias entre grupos. Resultados: Analizamos 18.120 pacientes (mediana = 83 anos, rango intercuartil [RIC] = 76-88; mujeres = 55,7%). El 44,6% presentaba > 3 síntomas/signos congestivos. Individualmente, el riesgo ajustado de muerte a 30 días se incrementó un 14% para la existencia de ingurgitación yugular (hazard ratio [HR] = 1,14; intervalo de confianza al 95% [IC 95%] = 1,01-1,28) y un 96% para la disnea de esfuerzo (HR = 1,96; IC 95% = 1,55-2,49). Valorados conjuntamente, el riesgo se incrementó progresivamente con el número de síntomas/signos presentes; así