Biocompatibility of two model elastin‐like recombinamer‐based hydrogels formed through physical or chemical cross‐linking for various applications in tissue engineering and regenerative medicine

Producción CientíficaBiocompatibility studies, especially innate immunity induction, in vitro and in vivo cytotoxicity, and fibrosis, are often lacking for many novel biomaterials including recombinant protein‐based ones, such as elastin‐like recombinamers (ELRs), and has not been extensively explored in the scientific literature, in contrast to traditional biomaterials. Herein, we present the results from a set of experiments designed to elucidate the preliminary biocompatibility of 2 types of ELRs that are able to form extracellular matrix‐like hydrogels through either physical or chemical cross‐linking both of which are intended for different applications in tissue engineering and regenerative medicine. Initially, we present in vitro cytocompatibility results obtained upon culturing human umbilical vein endothelial cells on ELR substrates, showing optimal proliferation up to 9 days. Regarding in vivo cytocompatibility, luciferase‐expressing hMSCs were viable for at least 4 weeks in terms of bioluminescence emission when embedded in ELR hydrogels and injected subcutaneously into immunosuppressed mice. Furthermore, both types of ELR‐based hydrogels were injected subcutaneously in immunocompetent mice and serum TNFα, IL‐1β, IL‐4, IL‐6, and IL‐10 concentrations were measured by enzyme‐linked immunosorbent assay, confirming the lack of inflammatory response, as also observed upon macroscopic and histological evaluation. All these findings suggest that both types of ELRs possess broad biocompatibility, thus making them very promising for tissue engineering and regenerative medicine‐related applications.European Commission (NMP-2014-646075, HEALTH-F4-2011-278557, PITN-GA-2012-317306 and MSCA-ITN-2014-642687)Ministerio de Economía, Industria y Competitividad (Projects MAT2016-78903-R, MAT2016-79435-R, MAT2013-42473-R, MAT2013-41723-R and MAT2012-38043)Junta de Castilla y León (programa de apoyo a proyectos de investigación – Ref.VA244U13 and VA313U14)Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y LeónInstituto de Salud Carlos III (grant RD12/0019/0017 )Fundação para a Ciência e Tecnologia (SFRH/BD/86451/ 2012

Risk factors for treatment failure and mortality among hospitalized patients with complicated urinary tract infection: A multicenter retrospective cohort study (RESCUING study group)

Background. Complicated urinary tract infections (cUTIs) are responsible for a major share of all antibiotic consumption in hospitals. We aim to describe risk factors for treatment failure and mortality among patients with cUTIs. Methods. A multinational, multicentre retrospective cohort study, conducted in 20 countries in Europe and the Middle East. Data were collected from patients' files on hospitalised patients with a diagnosis of cUTI during 2013-2014. Primary outcome was treatment failure, secondary outcomes included 30 days all-cause mortality,among other outcomes. Multivariable analysis using a logistic model and the hospital as a random variable was performed to identify independent predictors for these outcomes. Results. A total of 981 patients with cUTI were included. Treatment failure was observed in 26.6% (261/981), all cause 30-day mortality rate was 8.7% (85/976), most of these in patients with catheter related UTI (CaUTI). Risk factors for treatment failure in multivariable analysis were ICU admission (OR 5.07, 95% CI 3.18-8.07), septic shock (OR 1.92, 95% CI 0.93-3.98), corticosteroid treatment (OR 1.92, 95% CI 1.12-3.54), bedridden (OR 2.11, 95%CI 1.4-3.18), older age (OR 1.02, 95% CI 1.0071.03-), metastatic cancer (OR 2.89, 95% CI 1.46-5.73) and CaUTI (OR 1.48, 95% CI 1.04-2.11). Management variables, such as inappropriate empirical antibiotic treatment or days to starting antibiotics were not associated with treatment failure or 30-day mortality. More patients with pyelonephritis were given appropriate empirical antibiotic therapy than other CaUTI [110/171; 64.3% vs. 116/270; 43%, p <0.005], nevertheless, this afforded no advantage in treatment failure rates nor mortality in these patients. Conclusions. In patients with cUTI we found no benefit of early appropriate empirical treatment on survival rates or other outcomes. Physicians might consider supportive treatment and watchful waiting in stable patients until the causative pathogen is defined

Efficacy of AZM therapy in patients with gingival overgrowth induced by Cyclosporine A: a systematic review

<p>Abstract</p> <p>Background</p> <p>In daily clinical practice of a dental department it's common to find gingival overgrowth (GO) in periodontal patients under treatment with Cyclosporine A (CsA). The pathogenesis of GO and the mechanism of action of Azithromycin (AZM) are unclear. A systematic review was conducted in order to evaluate the efficacy of Azithromycin in patients with gingival overgrowth induced by assumption of Cyclosporine A.</p> <p>Methods</p> <p>A bibliographic search was performed using the online databases MEDLINE, EMBASE and Cochrane Central of Register Controlled Trials (CENTRAL) in the time period between 1966 and September 2008.</p> <p>Results</p> <p>The literature search retrieved 24 articles; only 5 were Randomised Controlled Trials (RCTs), published in English, fulfilled the inclusion criteria. A great heterogeneity between proposed treatments and outcomes was found, and this did not allow to conduct a quantitative meta-analysis. The systematic review revealed that a 5-day course of Azithromycin with Scaling and Root Planing reduces the degree of gingival overgrowth, while a 7-day course of metronidazole is only effective on concomitant bacterial over-infection.</p> <p>Conclusion</p> <p>Few RCTs on the efficacy of systemic antibiotic therapy in case of GO were found in the literature review. A systemic antibiotic therapy without plaque and calculus removal is not able to reduce gingival overgrowth. The great heterogeneity of diagnostic data and outcomes is due to the lack of precise diagnostic methods and protocols about GO. Future studies need to improve both diagnostic methods and tools and adequate classification aimed to determine a correct prognosis and an appropriate therapy for gingival overgrowth.</p

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo

Objetivo Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad. Material y métodos Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2.864 pacientes. Resultados Utilizando datos retrospectivos, 81 de los 314 médicos (25, 8% [IC del 95%, 21, 3 a 30, 9]) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28, 0% [IC del 95%, 23, 4 a 33, 2]) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0, 19, IC del 95%, 0, 13 a 0, 28) y presentar un asma persistente grave al inicio del estudio (OR 0, 20, IC del 95%, 0, 12 a 0, 34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1, 70, IC del 95%, 1, 40 a 2, 06). Conclusiones El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma. Objective: To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods: We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results: Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions: Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines

Calidad de vida relacionada con la salud y estrategias de afrontamiento ante el dolor en pacientes atendidos por una unidad de tratamiento del dolor

Introduction: The World Health Organisation (WHO) defines the quality of life (QOL) as a subjective evaluation of the characteristics of a person life, a composite variable referring to an individual's subjective overall satisfaction with life, a multidimensional construct primarily based on a person's subjective appraisal of their physical, functional, emotional and social well-being. Therefore health-related quality of life (HRQOL) refers to the extent to which one's usual or expected physical, emotional and social well-being are affected by a medical condition or its treatment. Objectives: Describe the different pathology of chronic no malign pain in patients who go for the first time to Unit of pain during 6 months and the treatment receive. Know the changes in health-related quality of life (HRQL), pain intensity, coping strategies and anxiety/depression after six months. Know the relation between HRQL, coping strategies, anxiety/depression and pain intensity in these patients. Know the changes in valúes which measures previous parameters in depending of diagnostic groups. Material and methods: This work is descriptive with measures repeated after 6 months about the population of patients that go to a Unit of pain Galdakao's Hospital during the second part of 2005. Several questionnaires are administrated about quality of life (SF-36), coping strategies (CAD-R), anxiety/depression (HAD) and intensity of pain (EVA). The questionnaire SF-36, CAD-R, HAD, and EVA were administered again and were collected the different treatment given by unit of pain. All proceedings were realized with the statistics packet SAS System v9.1, we assumed statistic signification with p< 0.05. Results and conclusions: The sample is composed of 119 patients, 93 completed the questionnaires, at the beginning and 6 months after, so we have 21.8% lost. In the SF-36 the improvement is significative in domains role physical, corporal pain, vitality, mental health and the standard physical component. In the HAD anxiety values, increase and depression values decrease in a no significative mode. Pain intensitivity is modérate, decreases in a no significative mode. Coping strategies more used are autoafirmation and the look for information, 6 months after, coping strategies active are more used. We can see the negative association between quality of life with anxiety and depression and pain intensitivity. The worst group responding to treatment by Unit of Pain is fibromyalgia patients.Introducción: La Organización Mundial de la Salud, define la calidad de vida como: "la percepción del individuo de su situación en la vida, dentro del contexto cultural y de valores en el que vive, y en relación con sus objetivos, expectativas, valores e intereses". Por lo tanto para una valoración completa de los beneficios producidos por un determinado tratamiento, es esencial medir su impacto en el estado de salud del paciente, lo que se denomina calidad de vida relacionada con la salud (CVRS). Objetivos: Describir las diferentes patologías de dolor crónico no maligno de los pacientes que acuden por primera vez a una unidad del dolor (UTD) a lo largo de 6 meses y el tratamiento recibido. Conocer los cambios en la CVRS, intensidad del dolor, estrategias de afrontamiento y ansiedad/depresión al cabo de 6 meses de seguimiento de estos pacientes. Conocer la relación entre CVRS, afrontamiento, ansiedad/depresión e intensidad del dolor en estos pacientes. Conocer los cambios en las puntuaciones que miden los parámetros anteriores según los grupos diagnósticos. Material y métodos: Estudio descriptivo con medidas repetidas a los 6 meses respecto a la población de pacientes que acuden a la UTD del Hospital de Galdakao (Bizkaia) durante el 2º semestre del 2005. Se administran varios cuestionarios, de calidad de vida (SF-36), de afrontamiento (CAD-R), ansiedad y depresión (HAD) y la intensidad del dolor (EVA). Al cabo de 6 meses se vuelven a administrar y se recogen los diferentes tratamientos realizados en la UTD. Todos los procedimientos fueron realizados con el paquete estadístico SAS System v9.1, se asumió significación estadística cuando p < 0.05. Resultados y conclusiones: La muestra la conforman 119 pacientes, de ellos 93 completaron los cuestionarios al inicio del estudio y al cabo de 6 meses, por lo que presentamos un 21.85 % de pérdidas. Los resultados del estudio muestran que los pacientes refieren una mejoría significativa en los dominios rol físico, dolor corporal y vitalidad del SF-36 al cabo de 6 meses de su paso por la UTD. Se observa una tendencia a que disminuya la intensidad del dolor y la sintomatología depresiva, sin embargo la sintomatología ansiosa tiende a aumentar. Las estrategias de afrontamiento más utilizadas por la muestra son las activas. Existe una asociación negativa entre el estado de salud con la sintomatología de ansiedad, depresión y la intensidad del dolor. Dentro de los grupos diagnósticos el grupo de fibromialgia y dolor osteoarticular es el que peor evoluciona, tanto en parámetros de intensidad de dolor, como en sintomatología ansiosa y depresiva