Industrial supply of trace elements during the “Anthropocene”: a record in estuarine sediments from the Ria of Ferrol (NW Iberian Peninsula)

This work addresses the study of a sediment core retrieved in the estuary of the Grande-de-Xubia River (Ria of Ferrol), which is among the first industrialized areas in the Iberian Peninsula and has links to the shipbuilding industry since 1750. The chemical analysis of trace elements (i.e. As, Cd, Co, Cr, Cu, Hg, Mo, Ni, Pb, V, and Zn) was coupled with 210Pb dating. The results span a period of about 130 years and cover the whole of the 20th century. Trace element anthropogenic fluxes accumulating in the sediments were calculated and show that human inputs are the most important sources for Cu, Cd, Hg and Zn, being, on average, well over the natural loads. The temporal variation in the anthropogenic contaminants allows the identification of four main phases describing the human-natural input interactions, which in chronological order, are: (i) early industrialization, (ii) industrial acceleration or first industrial transition, (iii) industrial collapse, and (iv) an industrial maturity or a second industrial transition.Ministerio de Ciencia e Innovación | Ref. CTM 2011-28792-C02-02Xunta de Galicia | Ref. ED481B-2019-06

Dating the Anthropocene in deep-sea sediments: a gamma spectrometric approach

1 poster presented at the International meeting of Sedimentology 2017 in Toulouse, France, from October 10th to 13thUtilizando muestras de sedimentos superficiales obtenidas durante la campaña OVIDE/BOCATS 2016 y una innovadora técnica para establecer cronologías absolutas, se ha obtenido una primera estimación cuantitativa de los flujos de carbono hacia sedimentos profundos en la cuenca subpolar de Irminger. La geocronología basada en espectrometría gamma de alta resolución y bajo fondo con dos detectores simultáneos de germanio hiper-puro (HPGe) es una técnica suficientemente precisa y sensible como para datar sedimentos pelágicos profundos. El papel cuantitativo del Irminger como sumidero de carbono durante el Antropoceno se evaluó combinando una cronología basada en el radionúclido natural 210Pb junto a análisis sedimentológicos y de composición elemental. La tasa media de sedimentación para el canal central del Irminger es de 0.83±0.14 mm·yr-1. Los cálculos de flujos de carbono concluyen que durante el Antropoceno 32±14 g·Cinorg·m-2·año-1 y 4.5±3 g·Corg·m-2·año-1 sedimentan en la cuenca del Irminger, suponiendo un considerable sumidero de carbono en el área cuantificado en más de 22 Tg-C·año−1N

OXY-SCORE: a new perspective for left ventricular hypertrophy diagnosis

Background: A recently developed global indicator of oxidative stress (OXY-SCORE), by combining individual plasma biomarkers of oxidative damage and antioxidant capacity, has been validated in several pathologies, but not in left ventricular hypertrophy (LVH). The aim of this study was to design and calculate a plasma oxidative stress global index for patients with LVH. Methods: A total of 70 consecutive adult patients were recruited in our institution and assigned to one of the two study groups (control group/LVH group) by an echocardiography study. We evaluated plasmatic biomarkers of oxidative damage (malondialdehyde and thiolated proteins) and antioxidant defense (total thiols, reduced glutathione, total antioxidant capacity, catalase, and superoxide dismutase activities) by spectrophotometry/fluorimetry in order to calculate a plasma oxidative stress global index (OXY-SCORE) in relation to LVH. Results: The OXY-SCORE exhibited a highly significant difference between the groups (p < 0.001). The area under the receiver operating characteristic curve was 0.74 (95% confidence interval (CI), 0.62–0.85; p < 0.001). At a cut-off value of −1, the 68.6% sensitivity and 68.6% specificity values suggest that OXY-SCORE could be used to screen for LVH. A multivariable logistic regression model showed a positive association (p = 0.001) between OXY-SCORE and LVH [odds ratio = 0.55 (95% CI, 0.39–0.79)], independent of gender, age, smoking, glucose, systolic and diastolic arterial pressure, dyslipidemia, estimated glomerular filtration rate, body mass index, and valvular/coronary disease. Conclusion: OXY-SCORE could help in the diagnosis of LVH and could be used to monitor treatment response.This work was supported by a grant from Spanish Health Ministry (number FIS 16/02069) and Fondos Fede

VITAL phase 2 study: Upfront 5-fluorouracil, mitomycin-C, panitumumab and radiotherapy treatment in nonmetastatic squamous cell carcinomas of the anal canal (GEMCAD 09-02)

Aim: VITAL, a phase II single-arm study, aimed to evaluate efficacy and safety of panitumumab addition to 5-fluorouracil (5-FU), mitomycin-C (MMC) and radiotherapy (RT) in patients with localized squamous cell carcinoma of the anal canal (SCCAC). Methods: Adult, treatment-naïve SCCAC patients (Stage T2-T4, any N, M0) and ECOG-PS ≤2, received panitumumab (6 mg/kg, day 1 and Q2W; 8 weeks), 5-FU (1000 mg/m2/d, days 1-4 and 29-32), MMC (10 mg/m2, days 1 and 29) and RT 45 Gy (1.8 Gy/fraction) to the primary tumor and mesorectal, iliac and inguinal lymph nodes, plus 10-15 Gy boost dose to the primary tumor and affected lymph nodes. The primary objective was disease free survival rate (DFS) at 3-years (expected 3-year DFS rate: 73.7 ± 12%). Results: Fifty-eight patients (31 women; median age: 59 years; ECOG-PS 0-1:98%; TNM II [29%] (T2 or T3/N0/M0)/IIIA (T1-T3/N1/M0 or T4/N0/M0) [21%]/IIIB (T4/N1/M0 or any T/N2 or N3/M0) [47%]/nonevaluable [4%]) were included. The median follow-up was 45 months. The 3-year DFS rate was 61.1% (95% CI: 47.1, 72.4). The 3-year overall survival rate was 78.4% (95% CI: 65.1, 87.1). Eighteen patients (31.0%) required a colostomy within 2 years posttreatment. Grade 3-4 toxicities were experienced by 53 (91%) patients. Most common grade 3-4 treatment-related events were radiation skin injury (40%) and neutropenia (24%). No toxic deaths occurred. Improved efficacy in colostomy-free survival and complete response rate was observed in human papilloma virus positive patients. Conclusions: Panitumumab addition to MMC-5FU regimen in SCCAC patients increases toxicity and does not improve patients’ outcomes. RT plus MMC-5FU remains the standard of care for localized SCCAC patients.This work was supported by Amgen S.A

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Dating the Anthropocene in deep-sea sediments: a gamma spectrometric approach

1 poster presented at the International meeting of Sedimentology 2017 in Toulouse, France, from October 10th to 13thUtilizando muestras de sedimentos superficiales obtenidas durante la campaña OVIDE/BOCATS 2016 y una innovadora técnica para establecer cronologías absolutas, se ha obtenido una primera estimación cuantitativa de los flujos de carbono hacia sedimentos profundos en la cuenca subpolar de Irminger. La geocronología basada en espectrometría gamma de alta resolución y bajo fondo con dos detectores simultáneos de germanio hiper-puro (HPGe) es una técnica suficientemente precisa y sensible como para datar sedimentos pelágicos profundos. El papel cuantitativo del Irminger como sumidero de carbono durante el Antropoceno se evaluó combinando una cronología basada en el radionúclido natural 210Pb junto a análisis sedimentológicos y de composición elemental. La tasa media de sedimentación para el canal central del Irminger es de 0.83±0.14 mm·yr-1. Los cálculos de flujos de carbono concluyen que durante el Antropoceno 32±14 g·Cinorg·m-2·año-1 y 4.5±3 g·Corg·m-2·año-1 sedimentan en la cuenca del Irminger, suponiendo un considerable sumidero de carbono en el área cuantificado en más de 22 Tg-C·año−1N

Dating the Anthropocene in deep-sea sediments: how much carbon is buried in the Irminger Basin?

31 pages, 5 figures.Evaluation of biogeochemical processes in Anthropocene deep-sea sediments require accurate dating techniques. Here we show the results of an approach using high resolution low level background gamma spectrometry with two simultaneous hyper-pure germanium (HPGe) detectors. The quantitative role of the deepest zones (>3000 m depth) of the Irminger Basin (Subpolar North Atlantic Ocean) as a carbon sink during the Anthropocene is evaluated combining a chronology based in the natural radionuclide 210Pb with sedimentological analysis and elemental composition. The average sedimentation rate of the central Irminger is 1.28 ± 0.18 mm·yr−1, with a mean weighted flux to the sediment for inorganic and organic carbon of 46 ± 15 g·Cinorg·m−2·yr−1 and 8 ± 1 g·Corg·m−2·yr−1. The biogenic fraction of the mass flux is increased since the XXth century. The contribution of the deepest zones of the Irminger Basin to the Anthropocene carbon sequestration in the North Atlantic Ocean is considerable at basin-scale.For this work M. Fontela was funded by the Spanish Ministry of Economy and Competitiveness through the BOCATS project supported by the Spanish Government.Peer reviewe

Plasma protein thiolation index (PTI) as a potential biomarker for left ventricular hypertrophy in humans.

BackgroundLeft ventricular hypertrophy (LVH) has been associated with oxidative stress, although not with the protein thiolation index (PTI). This study explored the potential use of PTI as a biomarker of oxidative stress in patients with LVH.MethodsWe recruited 70 consecutive patients (n = 35 LVH and n = 35 non-LVH) based on an echocardiography study in our institution (left ventricular mass indexed to body surface area). Plasma levels of both S-thiolated protein and total thiols were measured as biomarkers of oxidative stress by spectrophotometry, and PTI was calculated as the molar ratio between S-thiolated proteins and the total thiol concentration.ResultsValues for plasma S-thiolated proteins were higher in patients with LVH than in the control group (P = 0.01). There were no differences in total thiols between the LVH group and the control group. Finally, PTI was higher in patients with LVH than in the control group (P = 0.001). The area under the ROC curve was 0.75 (95% CI, 0.63-0.86; PConclusionsThe present study suggests that PTI could be a new biomarker of oxidative stress in patients with LVH