Prehospital point-of-care lactate increases the prognostic accuracy of national early warning score 2 for early risk stratification of mortality: results of a multicenter, observational study

The objective of this study was to assess whether the use of prehospital lactate (pLA) can increase the prognostic accuracy of the National Early Warning Score 2 (NEWS2) to detect the risk of death within 48 h. A prospective, multicenter study in adults treated consecutively by the emergency medical services (EMS) included six advanced life support (ALS) services and five hospitals. Patients were assigned to one of four groups according to their risk of mortality (low, low-medium, medium, and high), as determined by the NEWS2 score. For each group, the validity of pLA in our cohort was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. In this study, 3081 participants with a median age of 69 years (Interquartile range (IQR): 54–81) were included. The two-day mortality was 4.4% (137 cases). The scale derived from the implementation of the pLA improved the capacity of the NEWS2 to discriminate low risk of mortality, with an AUC of 0.910 (95% CI: 0.87–0.94; p < 0.001). The risk stratification provided by the NEWS2 can be improved by incorporating pLA measurement to more accurately predict the risk of mortality in patients with low risk.Fil: Martín Rodríguez, Francisco. Universidad de Valladolid; España. Emergency Medical Services; EspañaFil: López Izquierdo, Raul. Hospital Universitario Rio Hortega; EspañaFil: Delgado Benito, Juan F.. Emergency Medical Services; EspañaFil: Sanz García, Ancor. Universidad Autonoma de Madrid. Hospital Universitario de la Princesa; EspañaFil: Pozo Vegas, Carlos del. Hospital Clínico Universitario de Valladolid; EspañaFil: Castro Villamor, Miguel Ángel. Universidad de Valladolid; EspañaFil: Martín Conty, José Luis. Universidad de Castilla-La Mancha; EspañaFil: Ortega, Guillermo José. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Autonoma de Madrid. Hospital Universitario de la Princesa; Españ

Beef quality differentiation in the framework of the Serrana de Teruel endangered breed conservation programme

La Serrana de Teruel es una raza bovina en peligro de extinción, criada tradicionalmente en áreas montañosas del Sur de Aragón (España). Con objeto de recuperar la raza, se realizó la caracterización morfológica, zootécnica y genética de la población existente. La raza presentó un grado medio-alto de armonía y homogeneidad, siendo la mayoría de individuos de perfil recto, eumétricos y sublongilíneos, aunque de menor tamaño al observado en otras razas filogenéticamente próximas. Los estudios de biodiversidad mostraron niveles altos de variabilidad genética y bajos de consanguinidad, a pesar del censo reducido (240 individuos en 2010), y proporcionaron las bases para llevar a cabo un programa sostenible de conservación. Para garantizar su mantenimiento a largo plazo, los bancos de germoplasma mantienen 6400 dosis de semen y 74 embriones. Paralelamente, se analizó la viabilidad comercial de la raza, a través del estudio de la calidad de canal y carne de las categorías comerciales de ternero, añojo y cebón (castrados con 9 meses), con edades a sacrificio de 12, 22 y 22 meses y pesos vivos de 470, 720 y 660 kg, respectivamente. Finalmente, se realizó un análisis prospectivo, según la opinión de expertos, de una nueva carne de vacuno con denominación de calidad, llamada ‘Serrana de Teruel’. Estos trabajos muestran la posibilidad de realizar una producción alternativa, tipo cebón, susceptible de acogerse a distintivos de calidad diferenciada, que podrían suponer un incentivo para la explotación de la Serrana de Teruel frente a otras razas, lo que favorecería su conservación a medio plazo.Serrana de Teruel is an endangered cattle breed raised traditionally in the mountainous areas of Southern Aragon (Spain). With the aim of recovering the breed, a characterization was carried out to determine the morphology, husbandry and genetic values of the Serrana de Teruel breed. Individuals showed a medium to high degree of homogeneity and harmony, most of the animals being of straight profile, and eumetrical and sublongilineal individuals, although smaller in size than other phylogenetically proximate breeds. Biodiversity studies showed good diversity values despite the breed’s low effective population size (240 individuals in 2010). These studies provided the basis for a sustainable programme of genetic conservation. In order to guarantee long-term maintenance, germplasm banks contain 6400 doses of semen and 74 embryos. Concurrently, the commercial viability of the breed was studied by means of an analysis of carcass and meat quality from three commercial categories – yearling, bull and steer (castrated at 9 months old) – with ages at slaughter of 12, 22 and 22 months and live weights of 470, 720 and 660 kg,, respectively. Good performances and high-quality products with no commercial constraints in the beef market were obtained. Finally, a prospective study for a new beef quality product labelled ‘Serrana de Teruel’ was performed, according to the opinions of experts. These studies provide the standard requirements for the alternative production of a labelled beef product that might create an incentive for the production of the Serrana de Teruel breed among other breeds, and thus favour the conservation of the breed in the medium termLa Serrana de Teruel est une race bovine rustique élevée dans les régions montagneuses du sud de l’Aragon (Espagne) qui est en danger d’extinction. Afin de récupérer cette race on a réalisé la caractérisation morphologique, génétique et zootechnique de la population existante. La race présente un degré moyen-élevé d’harmonie et d’uniformité, la plupart des animaux étant de profil droit, eumétrique et sublongiligne, bien que plus petit en taille que les autres races proches. Des études sur la biodiversité ont montré des niveaux élevés de diversité génétique et un faible niveau de consanguinité, malgré les effectifs limités d’animaux (240 individus en 2010), en fournissant les bases du programme de conservation. Afin de garantir le maintien à long terme, a été créée une banque de matériel génétique contenant 6400 doses de semence et 74 embryons. En parallèle, on a confirmé la viabilité commerciale de la race à travers l’étude de la qualité de la carcasse et de la viande pour les catégories commerciales de veau, taurillon et bouvillons (castrés à 9 mois), avec des âges à l’abattage de 12, 22 et 22 mois, et 470, 720 et 660 kg de poids vif, respectivement. Enfin, nous avons mené une analyse prospective, à dires d’experts, pour un nouveau label de qualité du boeuf appelé ‘Serrana de Teruel’. Ces travaux montrent la possibilité d’une production alternative, comme boeuf, susceptible de bénéficier d’une certification de qualité, ce qui pourrait créer une incitation pour l’exploitation de la Serrana de Teruel parmi les autres races, et ainsi favoriser sa préservation à long termePublishe

A Single-Run Next-Generation Sequencing (NGS) Assay for the Simultaneous Detection of Both Gene Mutations and Large Chromosomal Abnormalities in Patients with Myelodysplastic Syndromes (MDS) and Related Myeloid Neoplasms

Chromosomal abnormalities and somatic mutations are found in patients with myelodysplastic syndromes (MDS) and myelodysplastic/myeloproliferative neoplasms (MDS/MPN) in around 50-80% of cases. The identification of these alterations is important for the accurate diagnosis and prognostic classification of these patients. Often, an apparently normal or failed karyotype might lead to an inadequate estimation of the prognostic risk, and several strategies should be combined to solve these cases. The aim of this study was to introduce a novel next-generation sequencing (NGS)-based strategy for the simultaneous detection of all the clinically relevant genetic alterations associated with these disorders. We validated this approach on a large cohort of patients by comparing our findings with those obtained with standard-of-care methods (i.e., karyotype and SNP-arrays). We show that our platform represents a significant improvement on current strategies in defining diagnosis and risk stratification of patients with MDS and myeloid-related disorders. Myelodysplastic syndromes (MDS) and myelodysplastic/myeloproliferative neoplasms are clonal disorders that share most of their cytogenetic and molecular alterations. Despite the increased knowledge of the prognostic importance of genetics in these malignancies, next-generation sequencing (NGS) has not been incorporated into clinical practice in a validated manner, and the conventional karyotype remains mandatory in the evaluation of suspected cases. However, non-informative cytogenetics might lead to an inadequate estimation of the prognostic risk. Here, we present a novel targeted NGS-based assay for the simultaneous detection of all the clinically relevant genetic alterations associated with these disorders. We validated this platform in a large cohort of patients by performing a one-to-one comparison with the lesions from karyotype and single-nucleotide polymorphism (SNP) arrays. Our strategy demonstrated an approximately 97% concordance with standard clinical assays, showing sensitivity at least equivalent to that of SNP arrays and higher than that of conventional cytogenetics. In addition, this NGS assay was able to identify both copy-neutral loss of heterozygosity events distributed genome-wide and copy number alterations, as well as somatic mutations within significant driver genes. In summary, we show a novel NGS platform that represents a significant improvement to current strategies in defining diagnosis and risk stratification of patients with MDS and myeloid-related disorder

Cost-effective mitigation of ammonia emissions from fertilizer use in Spanish agroecosystems

Mitigación GEI sistemas agrícola

Nanoinformatics: developing new computing applications for nanomedicine

Nanoinformatics has recently emerged to address the need of computing applications at the nano level. In this regard, the authors have participated in various initiatives to identify its concepts, foundations and challenges. While nanomaterials open up the possibility for developing new devices in many industrial and scientific areas, they also offer breakthrough perspectives for the prevention, diagnosis and treatment of diseases. In this paper, we analyze the different aspects of nanoinformatics and suggest five research topics to help catalyze new research and development in the area, particularly focused on nanomedicine. We also encompass the use of informatics to further the biological and clinical applications of basic research in nanoscience and nanotechnology, and the related concept of an extended ?nanotype? to coalesce information related to nanoparticles. We suggest how nanoinformatics could accelerate developments in nanomedicine, similarly to what happened with the Human Genome and other -omics projects, on issues like exchanging modeling and simulation methods and tools, linking toxicity information to clinical and personal databases or developing new approaches for scientific ontologies, among many others

Beef quality differentiation in the framework of Serrana de Teruel endangered breed conservation programme: abstract

Publishe

Spanish guidelines for the use of targeted deep sequencing in myelodysplastic syndromes and chronic myelomonocytic leukaemia

The landscape of medical sequencing has rapidly changed with the evolution of next generation sequencing (NGS). These technologies have contributed to the molecular characterization of the myelodysplastic syndromes (MDS) and chronic myelomonocytic leukaemia (CMML), through the identification of recurrent gene mutations, which are present in >80% of patients. These mutations contribute to a better classification and risk stratification of the patients. Currently, clinical laboratories include NGS genomic analyses in their routine clinical practice, in an effort to personalize the diagnosis, prognosis and treatment of MDS and CMML. NGS technologies have reduced the cost of large-scale sequencing, but there are additional challenges involving the clinical validation of these technologies, as continuous advances are constantly being made. In this context, it is of major importance to standardize the generation, analysis, clinical interpretation and reporting of NGS data. To that end, the Spanish MDS Group (GESMD) has expanded the present set of guidelines, aiming to establish common quality standards for the adequate implementation of NGS and clinical interpretation of the results, hoping that this effort will ultimately contribute to the benefit of patients with myeloid malignancies

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London