Simultaneous Pancreas Kidney Transplantation Improves Cardiovascular Autonomic Neuropathy with Improved Valsalva Ratio as the Most Precocious Test

[EN] Background. Simultaneous pancreas-kidney (SPK) transplantation is a proven option of treatment for patients with type 1 diabetes mellitus (T1DM) and related end-stage renal disease. There is discrepancy between the results of different studies about the impact of prolonged normalization of glucose metabolism achieved by SPK on the course of diabetic complications including severe forms of diabetic neuropathy. The objective of the study was to evaluate the prevalence of cardiovascular autonomic neuropathy (CAN) in patients undergoing SPK transplantation and its evolution 10 years after transplantation. Methods. Prospective study of 81 patients transplanted in a single center from year 2002 to 2015. Autonomic function was assessed using cardiovascular autonomic reflex tests (CARTs). CARTs were made before SPK transplantation and during the follow-up. Evolution of tests after SPK transplantation was evaluated by contrasting hypotheses (paired tests). Multiple testing was adjusted with the Benjamini-Hochberg procedure with a false discovery rate of 10%. Results. 48 males and 33 females, mean age 37.4 +/- 5.7 years, mean BMI 24.0 +/- 3.4 kg/m2, and mean duration of diabetes 25.5 +/- 6.5 years, received SPK transplantation. Ten years after SPK transplantation, 56 patients re tained the pancreatic graft (42 of them with normofunctioning pancreas and 14 with low doses of insulin therapy). These 42 patients were selected for the autonomic study. Before transplant procedure, all CART results were abnormal. After SPK transplantation, paired test analysis showed an improvement of systolic blood pressure (SBP) response to orthostasis at the 5(th) year after SPK (p=0.03), as well as improvement of the Valsalva ratio at the 3(rd) (p<0.001) and 5(th) (p=0.001) year after SPK. After correcting for the false discovery rate, all the variables of autonomic study reached significance at different time points. Conclusions. Prevalence of CAN in patients who are candidates for SPK transplantation is high and is generally advanced. SPK transplantation improves CAN with improved Valsalva ratio as the most precocious test.Argente-Pla, M.; Pérez-Lázaro, A.; Martinez-Millana, A.; Del Olmo-García, MI.; Espí-Reig, J.; Beneyto-Castello, I.; López-Andújar, R.... (2020). Simultaneous Pancreas Kidney Transplantation Improves Cardiovascular Autonomic Neuropathy with Improved Valsalva Ratio as the Most Precocious Test. Journal of Diabetes Research. 2020:1-10. https://doi.org/10.1155/2020/7574628S1102020Freeman, R. (2014). Diabetic autonomic neuropathy. Handbook of Clinical Neurology, 63-79. doi:10.1016/b978-0-444-53480-4.00006-0Maser, R. E., Mitchell, B. D., Vinik, A. I., & Freeman, R. (2003). The Association Between Cardiovascular Autonomic Neuropathy and Mortality in Individuals With Diabetes: A meta-analysis. Diabetes Care, 26(6), 1895-1901. doi:10.2337/diacare.26.6.1895Dimitropoulos, G. (2014). Cardiac autonomic neuropathy in patients with diabetes mellitus. World J Diabetes, 5(1), 17. doi:10.4239/wjd.v5.i1.17Vinik, A. I., & Ziegler, D. (2007). Diabetic Cardiovascular Autonomic Neuropathy. Circulation, 115(3), 387-397. doi:10.1161/circulationaha.106.634949Kennedy, W. R., Navarro, X., & Sutherland, D. E. R. (1995). Neuropathy profile of diabetic patients in a pancreas transplantation program. Neurology, 45(4), 773-780. doi:10.1212/wnl.45.4.773Pop-Busui, R., Boulton, A. J. M., Feldman, E. L., Bril, V., Freeman, R., Malik, R. A., … Ziegler, D. (2016). Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care, 40(1), 136-154. doi:10.2337/dc16-2042Balcıoğlu, A. S. (2015). Diabetes and cardiac autonomic neuropathy: Clinical manifestations, cardiovascular consequences, diagnosis and treatment. World Journal of Diabetes, 6(1), 80. doi:10.4239/wjd.v6.i1.80Pop-Busui, R., Low, P. A., Waberski, B. H., Martin, C. L., Albers, J. W., Feldman, E. 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Impact of pancreas transplantation on type 1 diabetes-related complications. Current Opinion in Organ Transplantation, 15(1), 119-123. doi:10.1097/mot.0b013e32833552bcKennedy, W. R., Navarro, X., Goetz, F. C., Sutherland, D. E. R., & Najarian, J. S. (1990). Effects of Pancreatic Transplantation on Diabetic Neuropathy. New England Journal of Medicine, 322(15), 1031-1037. doi:10.1056/nejm199004123221503Bouček, P., Bartoš, V., Vaněk, I., Hýža, Z., & Skibová, J. (1991). Diabetic autonomic neuropathy after pancreas and kidney transplantation. Diabetologia, 34(S1), S121-S124. doi:10.1007/bf00587636Navarro, X., Sutherland, D. E. R., & Kennedy, W. R. (1997). Long-term effects of pancreatic transplantation on diabetic neuropathy. Annals of Neurology, 42(5), 727-736. doi:10.1002/ana.410420509Solders, G., Tyden, G., Persson, A., & Groth, C.-G. (1992). Improvement of Nerve Conduction in Diabetic Neuropathy: A Follow-up Study 4 Yr After Combined Pancreatic and Renal Transplantation. Diabetes, 41(8), 946-951. doi:10.2337/diab.41.8.946Argente-Pla, M., Martínez-Millana, A., Del Olmo-García, M. I., Espí-Reig, J., Pérez-Rojas, J., Traver-Salcedo, V., & Merino-Torres, J. F. (2019). Autoimmune Diabetes Recurrence After Pancreas Transplantation: Diagnosis, Management, and Literature Review. Annals of Transplantation, 24, 608-616. doi:10.12659/aot.920106Sundkvist, G., & Lilja, B. (1985). Autonomic Neuropathy in Diabetes Mellitus: A Follow-up Study. Diabetes Care, 8(2), 129-133. doi:10.2337/diacare.8.2.129Boulton, A. J. M., Vinik, A. I., Arezzo, J. C., Bril, V., Feldman, E. L., Freeman, R., … Ziegler, D. (2005). Diabetic Neuropathies: A statement by the American Diabetes Association. Diabetes Care, 28(4), 956-962. doi:10.2337/diacare.28.4.956Ewing, D. J., Martyn, C. N., Young, R. J., & Clarke, B. F. (1985). The Value of Cardiovascular Autonomic Function Tests: 10 Years Experience in Diabetes. Diabetes Care, 8(5), 491-498. doi:10.2337/diacare.8.5.491Spallone, V., Bellavere, F., Scionti, L., Maule, S., Quadri, R., Bax, G., … Morganti, R. (2011). Recommendations for the use of cardiovascular tests in diagnosing diabetic autonomic neuropathy☆. Nutrition, Metabolism and Cardiovascular Diseases, 21(1), 69-78. doi:10.1016/j.numecd.2010.07.005Agashe, S., & Petak, S. (2018). Cardiac Autonomic Neuropathy in Diabetes Mellitus. Methodist DeBakey Cardiovascular Journal, 14(4), 251. doi:10.14797/mdcj-14-4-251Valensi, P., Pariès, J., & Attali, J. . (2003). Cardiac autonomic neuropathy in diabetic patients: influence of diabetes duration, obesity, and microangiopathic complications—the french multicenter study. Metabolism, 52(7), 815-820. doi:10.1016/s0026-0495(03)00095-7Tesfaye, S., Boulton, A. J. M., Dyck, P. J., Freeman, R., Horowitz, M., … Kempler, P. (2010). Diabetic Neuropathies: Update on Definitions, Diagnostic Criteria, Estimation of Severity, and Treatments. Diabetes Care, 33(10), 2285-2293. doi:10.2337/dc10-1303Benjamini, Y., & Hochberg, Y. (1995). Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing. Journal of the Royal Statistical Society: Series B (Methodological), 57(1), 289-300. doi:10.1111/j.2517-6161.1995.tb02031.xAdler, G. K., Bonyhay, I., Failing, H., Waring, E., Dotson, S., & Freeman, R. (2008). Antecedent Hypoglycemia Impairs Autonomic Cardiovascular Function: Implications for Rigorous Glycemic Control. Diabetes, 58(2), 360-366. doi:10.2337/db08-1153HATHAWAY, D. K., ABELL, T., CARDOSO, S., HARTWIG, M. S., GEBELY, S. E., & Gaber, A. O. (1994). IMPROVEMENT IN AUTONOMIC AND GASTRIC FUNCTION FOLLOWING PANCREAS-KIDNEY VERSUS KIDNEY-ALONE TRANSPLANTATION AND THE CORRELATION WITH QUALITY OF LIFE1,2. Transplantation, 57(6), 816-822. doi:10.1097/00007890-199403270-00008Arnold, R., Pussell, B. A., Pianta, T. J., Lin, C. S.-Y., Kiernan, M. C., & Krishnan, A. V. (2013). Association Between Calcineurin Inhibitor Treatment and Peripheral Nerve Dysfunction in Renal Transplant Recipients. American Journal of Transplantation, 13(9), 2426-2432. doi:10.1111/ajt.12324Vinik, A. I., Maser, R. E., Mitchell, B. D., & Freeman, R. (2003). Diabetic Autonomic Neuropathy. Diabetes Care, 26(5), 1553-1579. doi:10.2337/diacare.26.5.1553Suarez, G. A. (2005). Sudden cardiac death in diabetes mellitus: risk factors in the Rochester diabetic neuropathy study. Journal of Neurology, Neurosurgery & Psychiatry, 76(2), 240-245. doi:10.1136/jnnp.2004.039339Dinh, W., Füth, R., Lankisch, M., Bansemir, L., Nickl, W., Scheffold, T., … Ziegler, D. (2010). Cardiovascular autonomic neuropathy contributes to left ventricular diastolic dysfunction in subjects with Type 2 diabetes and impaired glucose tolerance undergoing coronary angiography. Diabetic Medicine, no-no. doi:10.1111/j.1464-5491.2010.03221.xWackers, F. J. T., Young, L. H., Inzucchi, S. E., Chyun, D. A., Davey, J. A., Barrett, E. J., … Iskandrian, A. E. (2004). Detection of Silent Myocardial Ischemia in Asymptomatic Diabetic Subjects: The DIAD study. Diabetes Care, 27(8), 1954-1961. doi:10.2337/diacare.27.8.1954Astrup, A. S., Tarnow, L., Rossing, P., Hansen, B. V., Hilsted, J., & Parving, H.-H. (2006). Cardiac Autonomic Neuropathy Predicts Cardiovascular Morbidity and Mortality in Type 1 Diabetic Patients With Diabetic Nephropathy. Diabetes Care, 29(2), 334-339. doi:10.2337/diacare.29.02.06.dc05-1242Pop-Busui, R., Evans, G. W., Gerstein, H. C., Fonseca, V., Fleg, J. L., … Hoogwerf, B. J. (2010). Effects of Cardiac Autonomic Dysfunction on Mortality Risk in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial. Diabetes Care, 33(7), 1578-1584. doi:10.2337/dc10-0125Kempler, P., Tesfaye, S., Chaturvedi, N., Stevens, L. K., Webb, D. J., … Eaton, S. (2002). Autonomic neuropathy is associated with increased cardiovascular risk factors: the EURODIAB IDDM Complications Study. 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Guiding the humoral response against HIV-1 toward a MPER adjacent region by immunization with a VLP-formulated antibody-selected envelope variant

Preventive HIV-1 vaccine strategies rely on the elicitation of broadly neutralizing antibody (bNAb) responses, but their induction in vivo by vaccination remains challenging. Considering that the ability of an epitope to elicit effective humoral immunity depends on its exposure on the virion, we have used a reverse genetics approach to select variants from an HIV-1 AC10_29 randomly mutated envelope library that showed increased affinity for a selected bNAb (4E10 bNAb targeting the HIV-1 MPER region). Isolated envelope sequences were analyzed by deep-sequencing showing a small number of dominant changes, including the loss of four potential N-linked glycosylation sites and disruption of the V1/V2 loop. Accordingly, the dominant variant (LR1-C1), showed not only increased affinity for MPER bNAbs 4E10 and 2F5, but also higher affinity for an additional antibody targeting the V3 loop (447-52D) that could be a consequence of an open conformation tier 1-like Env. Furthermore, the amino acids specific for the selected variant are associated with an increased sensitivity for 4E10 and 2F5 antibodies. In vivo studies showed that sera from mice immunized with LR1-C1 viruses possessed an improved neutralizing activity compared to the wild-type AC10_29 env. While Virus Like Particles (VLPs) carrying this envelope were unable to induce detectable neutralizing activity in immunized rabbits, one animal showed antibody response to the 4E10-proximal region. Our data establish a novel approach that has the potential to yield HIV envelope immunogen sequences that direct antibody responses to specific envelope regions

ABCG2 transporter plays a key role in the biodistribution of melatonin and its main metabolites

[EN] The ATP-binding cassette G2 (ABCG2) is an efflux transporter expressed in the apical membrane of cells from a large number of tissues, directly affecting bioavailability, tissue accumulation, and secretion into milk of both xenobiotics and endogenous compounds. The aim of this work was to characterize the role of ABCG2 in the systemic distribution and secretion into milk of melatonin and its main metabolites, 6-hydroxymelatonin, and 6-sulfatoxymelatonin. For this purpose, we first showed that these three molecules are transported by this transporter using in vitro transepithelial assays with MDCK-II polarized cells transduced with different species variants of ABCG2. Second, we tested the in vivo effect of murine Abcg2 in the systemic distribution of melatonin and its metabolites using wild-type and Abcg2−/− mice. Our results show that after oral administration of melatonin, the plasma concentration of melatonin metabolites in Abcg2−/− mice was between 1.5 and 6-fold higher compared to the wild-type mice. We also evaluated in these animals differences in tissue accumulation of melatonin metabolites. The most relevant differences between both types of mice were found for small intestine and kidney (>sixfold increase for 6-sulfatoxymelatonin in Abcg2−/− mice). Finally, melatonin secretion into milk was also affected by the murine Abcg2 transporter, with a twofold higher milk concentration in wild-type compared with Abcg2−/− lactating female mice. In addition, melatonin metabolites showed a higher milk-to-plasma ratio in wild-type mice. Overall, our results show that the ABCG2 transporter plays a critical role in the biodistribution of melatonin and its main metabolites, thereby potentially affecting their biological and therapeutic activity.SIPublicación en abierto financiada por el Consorcio de Bibliotecas Universitarias de Castilla y León (BUCLE), con cargo al Programa Operativo 2014ES16RFOP009 FEDER 2014-2020 DE CASTILLA Y LEÓN, Actuación:20007-CL - Apoyo Consorcio BUCL

A Study on Physical Exercise and General Mobility in People with Cerebral Palsy: Health through Costless Routines

[Abstract] Sedentary behavior (SB) is a common problem that may produce health issues in people with cerebral palsy (CP). When added to a progressive reduction in motor functions over time, SB can lead to higher percentages of body fat, muscle stiffness and associated health issues in this population. Regular physical activity (RPA) may prevent the loss of motor skills and reduce health risks. In this work, we analyzed data collected from 40 people (20 children and teenagers, and 20 adults) who attend two specialist centers in Seville to obtain an up-to-date picture regarding the practice of RPA in people with CP. Roughly 60% of the participants showed mostly mid/severe mobility difficulties, while 38% also had communicative issues. Most of the participants performed light-intensity physical activity (PA) at least once or twice a week and, in the majority of cases, had a neutral or positive attitude to exercising. In the Asociación Sevillana de Parálisis Cerebral (ASPACE) sample test, the higher the International Classification of Functioning, Disability and Health (ICF), the higher the percentage of negative responses to doing exercise. Conversely, in the Centro Específico de Educación Especial Mercedes Sanromá (CEEEMS), people likes PA but slightly higher ratios of positive responses were found at Gross Motor Function Classification System (GMFCS) levels V and II, agreeing with the higher personal engagement of people at those levels. We have also performed a literature review regarding RPA in CP and the use of low-cost equipment. As a conclusion, we found that RPA produces enormous benefits for health and motor functions, whatever its intensity and duration. Costless activities such as walking, running or playing sports; exercises requiring low-cost equipment such as elastic bands, certain smartwatches or video-games; or therapies with animals, among many others, have all demonstrated their suitability for such a purpose.This research was funded by the Spanish Ministry of Science and Innovation, State Plan 2017–2020: Challenges—R&D&I Projects with grant codes PID2019-104323RB-C32 and PID2019-104323RB-C33

Metformin modifies glutamine metabolism in an in vitro and in vivo model of hepatic encephalopathy

Aim: to analyze the effect of metformin on ammonia production derived from glutamine metabolism in vitro and in vivo. Methods: twenty male Wistar rats were studied for 28 days after a porto-caval anastomosis (n = 16) or a sham operation (n = 4). Porto-caval shunted animals were randomized into two groups (n = 8) and either received 30 mg/kg/day of metformin for two weeks or were control animals. Plasma ammonia concentration, Gls gene expression and K-type glutaminase activity were measured in the small intestine, muscle and kidney. Furthermore, Caco2 were grown in different culture media containing glucose/glutamine as the main carbon source and exposed to different concentrations of the drug. The expression of genes implicated in glutamine metabolism were analyzed. Results: metformin was associated with a significant inhibition of glutaminase activity levels in the small intestine of porto-caval shunted rats (0.277 ± 0.07 IU/mg vs 0.142 ± 0.04 IU/mg) and a significant decrease in plasma ammonia (204.3 ± 24.4 μg/dl vs 129.6 ± 16.1 μg/dl). Glucose withdrawal induced the expression of the glutamine transporter SLC1A5 (2.54 ± 0.33 fold change; p < 0.05). Metformin use reduced MYC levels in Caco2 and consequently, SLC1A5 and GLS expression, with a greater effect in cells dependent on glutaminolytic metabolism. Conclusion: metformin regulates ammonia homeostasis by modulating glutamine metabolism in the enterocyte, exerting an indirect control of both the uptake and degradation of glutamine. This entails a reduction in the production of metabolites and energy through this pathway and indirectly causes a decrease in ammonia production that could be related to a decreased risk of HE development.Junta de Andalucía. Consejería de Innovación, Ciencia y Empresa PIE-CTS-799

Description of the exposure of the most-followed spanish instamom's children to social medias

There is evidence of the risk of overexposure of children on social networks by parents working as influencers. A cross-sectional study of the profiles of the sixteen most-followed Instamoms in Spain was carried out. An analysis of these profiles was performed over a full month (April 2022), three times a week, to describe the representation of influencers’ children in the posts shared by them, as well as their role in the Instamoms’ marketing. A total of 192 evaluations of the profiles were performed in the study period. The average number of children exposed by an Instamom was three, generally preschoolers and schoolchildren. The children appear in a context of the family home and accompanied by their mother. The type of advertising that accompanies the appearance of underage children is usually women or children’s clothing, but also food products, leisure, etc. Appearance of children in the posts had a statistically significant influence on followers measured by the number of likes. Results provided the identification of two Instamom clusters with differentiated behaviors in relation to appearance of children in posts. It is important to involve Social Pediatrics in the protection of the privacy and interests of children given the increase in sharenting. The authors believe that there are concerns about their explicit consent to public exposure from early childhood and about the medium and long-term effect that this may have on their future well-being

Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort: 2004–2013

SummaryObjectivesTo analyze the impact of late presentation (LP) on overall mortality and causes of death and describe LP trends and risk factors (2004–2013).MethodsCox models and logistic regression were used to analyze data from a nation-wide cohort in Spain. LP is defined as being diagnosed when CD4 < 350 cells/ml or AIDS.ResultsOf 7165 new HIV diagnoses, 46.9% (CI95%:45.7–48.0) were LP, 240 patients died.First-year mortality was the highest (aHRLP.vs.nLP = 10.3[CI95%:5.5–19.3]); between 1 and 4 years post-diagnosis, aHRLP.vs.nLP = 1.9(1.2–3.0); and >4 years, aHRLP.vs.nLP = 1.5(0.7–3.1).First-year's main cause of death was HIV/AIDS (73%); and malignancies among those surviving >4 years (32%). HIV/AIDS-related deaths were more likely in LP (59.2% vs. 25.0%; p < 0.001). LP declined from 55.9% (2004–05) to 39.4% (2012–13), and reduced in 46.1% in men who have sex with men (MSM) and 37.6% in heterosexual men, but increased in 22.6% in heterosexual women.Factors associated with LP: sex (ORMEN.vs.WOMEN = 1.4[1.2–1.7]); age (OR31–40.vs.<30 = 1.6[1.4–1.8], OR41–50.vs.<30 = 2.2[1.8–2.6], OR>50.vs.<30 = 3.6[2.9–4.4]); behavior (ORInjectedDrugUse.vs.MSM = 2.8[2.0–3.8]; ORHeterosexual.vs.MSM = 2.2[1.7–3.0]); education (ORPrimaryEducation.vs.University = 1.5[1.1–2.0], ORLowerSecondary.vs.University = 1.3[1.1–1.5]); and geographical origin (ORSub-Saharan.vs.Spain = 1.6[1.3–2.0], ORLatin-American.vs.Spain = 1.4[1.2–1.8]).ConclusionsLP is associated with higher mortality, especially short-term- and HIV/AIDS-related mortality. Mid-term-, but not long-term mortality, remained also higher in LP than nLP. LP decreased in MSM and heterosexual men, not in heterosexual women. The groups most affected by LP are low educated, non-Spanish and heterosexual women

Safety and effectiveness of isavuconazole in real-life non-neutropenic patients

Objectives: Information is scarce on clinical experiences with non-neutropenic patients with invasive fungal infection (IFI) receiving isavuconazole. We aimed to report the safety and effectiveness of this drug as a first-line treatment or rescue in real life. Methods: A retrospective, observational multicentric study of non-neutropenic patients who received isavuconazole as an IFI treatment at 12 different university hospitals (January 2018-2022). All patients met criteria for proven, probable or possible IFI according to EORTC-MSG. Results: A total of 238 IFIs were treated with isavuconazole during the study period. Combination therapy was administered in 27.7% of cases. The primary IFI was aspergillosis (217, 91.2%). Other IFIs treated with isavuconazole were candidemia (n = 10), mucormycosis (n = 8), histoplasmosis (n = 2), cryptococcosis (n = 2), and others (n = 4). Median time of isavuconazole treatment was 29 days. Only 5.9% (n = 14) of cases developed toxicity, mainly hepatic-related (10 patients, 4.2%). Nine patients (3.8%) had treatment withdrawn. Successful clinical response at 12 weeks was documented in 50.5% of patients. Conclusion: Isavuconazole is an adequate treatment for non-neutropenic patients with IFIs. Toxicity rates were low and its effectiveness was comparable to other antifungal therapies previously reported. (c) 2024 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/

The Spanish Infrared Camera onboard the EUSO-BALLOON (CNES) flight on August 24, 2014

The EUSO-Balloon (CNES) campaign was held during Summer 2014 with a launch on August 24. In the gondola, next to the Photo Detector Module (PDM), a completely isolated Infrared camera was allocated. Also, a helicopter which shooted flashers flew below the balloon. We have retrieved the Cloud Top Height (CTH) with the IR camera, and also the optical depth of the nonclear atmosphere have been inferred with two approaches: The first one is with the comparison of the brightness temperature of the cloud and the real temperature obtained after the pertinent corrections. The second one is by measuring the detected signal from the helicopter flashers by the IR Camera, considering the energy of the flashers and the location of the helicopter

Revisiting the epidemiology of bloodstream infections and healthcare-associated episodes: results from a multicentre prospective cohort in Spain (PRO-BAC Study)

PROBAC REIPI/GEIH-SEIMC/SAEI Group.The epidemiology of bloodstream infections (BSIs) is dynamic as it depends on microbiological, host and healthcare system factors. The aim of this study was to update the information regarding the epidemiology of BSIs in Spain considering the type of acquisition. An observational, prospective cohort study in 26 Spanish hospitals from October 2016 through March 2017 including all episodes of BSI in adults was performed. Bivariate analyses stratified by type of acquisition were performed. Multivariate analyses were performed by logistic regression. Overall, 6345 BSI episodes were included; 2510 (39.8%) were community-acquired (CA), 1661 (26.3%) were healthcare-associated (HCA) and 2056 (32.6%) hospital-acquired (HA). The 30-day mortality rates were 11.6%, 19.5% and 22.0%, respectively. The median age of patients was 71 years (interquartile range 60–81 years) and 3656 (58.3%; 95% confidence interval 57.1–59.6%) occurred in males. The proportions according to patient sex varied according to age strata. Escherichia coli (43.8%), Klebsiella spp. (8.9%), Staphylococcus aureus (8.9%) and coagulase-negative staphylococci (7.4%) were the most frequent pathogens. Multivariate analyses confirmed important differences between CA and HCA episodes, but also between HCA and HA episodes, in demographics, underlying conditions and aetiology. In conclusion, we have updated the epidemiological information regarding patients’ profiles, underlying conditions, frequency of acquisition types and aetiological agents of BSI in Spain. HCA is confirmed as a distinct type of acquisition.This work was financed by grants from Plan Nacional de I+D+i 2013–2016, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades [PI16/01432] and the Spanish Network for Research in Infectious Diseases (REIPI) [RD16/0016/0001; RD16/0016/0008], co‐financed by the European Development Regional Fund ‘A way to achieve Europe’, Operative program Intelligent Growth 2014–2020