Cell wall disassembly is delayed by rhamnogalacturonate lyase gene silencing: potential role in fruit firmness

Strawberry fruits greatly reduce their quality due to softening during ripening with economically important losses. Texture changes of fleshy fruits during ripening are mainly due to middle lamellae dissolution, cell-to-cell adhesion losses and wall weakening of parenchyma cells by the coordinated action of several cell wall enzymes. Pectin degradation has been proven a key factor in strawberry softening by functional analysis of several pectinase genes (polygalacturonase, pectate lyase and -galactosidase). The complexity and highly dynamic nature of pectins remains a challenge to fully elucidate structure-function relationships of pectins. In this work, we present the functional analysis of two independent strawberry transgenic lines with more than 95% silencing of a rhamnogalacturonate lyase gene (FaRGLyase1). Firmness of ripe fruit was significantly higher in both transgenic lines than in the control. Cell walls from these fruits were extracted and analyzed by glycan microarray profiling. This high‐throughput technique allows a wide screening of cell-wall glycan occurrence based on the detection of specific cell wall oligosaccharide epitopes by monoclonal antibodies and reveals profiles which can be used as potential fingerprints specific for a singular organ and/or developmental stage. Our microarray results showed that the silencing of FaRGLyase1 reduced degradation of several rhamnogalacturonan-I related epitopes, as expected. Additionally, comparison of transgenic cell walls from ripe fruits with those extracted from control fruits at different developmental stages (green, white and red) by hierarchical clustering, demonstrated a higher similarity of transgenic fruit cell walls with the control cell walls from fruits at the white stage. Glycan microarray profiles revealed less degraded fruit cell walls as result of FaRGLyase1 down-regulation which could contribute to the increased firmness of transgenic fruitsUniversidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study

Background: The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes. Methods: LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January–December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien–Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141). Results: A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively. Conclusions: This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

La supervivencia de las personas sometidas a diálisis

La supervivencia de los pacientes con enfermedad renal crónica que inician tratamiento renal sustitutivo es un problema a resolver pues pese a los avances que se han producido en la atención nefrológica desde la segunda mitad del siglo pasado, su expectativa de vida es muy corta comparada con la población general1,2. Aunque existen diferencias notables en la morbimortalidad de unos países a otros, incluso entre los sanitariamente avanzados y a pesar de los avances técnicos en hemodiálisis, en los últimos años ha mejorado muy poco su supervivencia debido entre otros factores a que la edad y la comorbilidad de estos pacientes cada vez es mayor. Grandes estudios observacionales prospectivos, como el Dialysis Outcomes and Practice Patterns Study (DOPPS)3 o poblacionales el United States Renal Data System Diálisis Morbidity and Mortality Wave 24, han proporcionado una información muy valiosa sobre la trascendencia de determinados factores en la morbimortalidad de los pacientes5. En España, además de los registros como el GREG, existen también estudios epidemiológicos prospectivos6,7 que han aportado datos muy concluyentes respecto a los resultados, y que además sugieren áreas de mejora. La metodología de estos estudios es muy importante a la hora de valorar sus resultados pero, tanto en los de tipo registro poblacional como en los prospectivos, se pone de manifiesto de que además de la edad, existen otras características inherentes en los pacientes o relacionadas con la práctica de la hemodiálisis que influyen en su supervivencia8. Aunque las causas cardiovasculares en conjunto y las infecciones son las causas más frecuentes en todas las series, a grandes rasgos y teniendo en cuenta datos generales, puede cifrarse la mortalidad de estos pacientes en el 14 % mientras que la supervivencia a los 5 años es cercana al 56%. Los estudios citados sugieren que estos resultados pueden mejorar al aumentar el tiempo de la diálisis, aplicar técnicas conectivas o utilizar como acceso vascular de elección la fístula arteriovenosa interna6,7. Además de coincidir en estos resultados, diferentes autores han profundizado en aspectos puntuales que también se han mostrado significativos en relación con este tema

Intervención enfermera “círculos de diálogo” para la disminución del nivel de sobrecarga de cuidadores de pacientes crónico complejos y con enfermedad crónica avanzada

Introduction. The increase in life expectancy has led to an aging population and a higher prevalence of chronic diseases. This has generated the need for informal caregivers of the elderly to face caregiving situations. On the other hand, there has been a change in the epidemiological profile of the last 50 years, where there is a decrease in infectious diseases and a higher prevalence of non-communicable diseases of chronic course such as, which increase the demand of caregivers relatives. Caring for a dependent family member can negatively affect the health of the caregiver in their emotional and working life. Objectives. In the first phase, the general objective is to describe the sociodemographic characteristics of the study sample, as specific, to analyze the relationship between the level of caregiver burden and the sociodemographic variables of the main caregivers, to analyze the relationship between the level of caregiver burden and the clinical characteristics of the patient. In a second phase, it is to determine the effectiveness of the dialogue circles nurse intervention, to reduce the level of burden perceived by the main caregivers of patients identified as complex chronic patients and advanced chronic disease. As specific they are, comparing the level of overload perceived by the main caregivers before and after the intervention between the experimental group and the control group and the degree of satisfaction about the intervention nurse dialogue circles. Methodology. Quantitative study in two phases. In the first a descriptive cross-sectional study and in the second an experimental study, a randomized clinical trial with simple masking. The study will be carried out in Catalonia, in the towns of the metropolitan area of Barcelona, belonging to the Baix Llobregat Center Primary Care Service.Introducción. El aumento de la esperanza de vida ha originado el envejecimiento de la población y una mayor prevalencia de enfermedades crónicas. Esto ha generado la necesidad de cuidadores informales de adultos mayores para enfrentar situaciones de cuidado de estos. Por otra parte, se ha evidenciado un cambio en el perfil epidemiológico de los últimos 50 años, donde se observa un descenso de las enfermedades de tipo infeccioso y una mayor prevalencia de enfermedades no trasmisibles de curso crónico, las cuales aumentan la demanda de los cuidadores familiares. El cuidado de un familiar dependiente puede afectar negativamente en la salud del cuidador/a, en su vida afectiva y laboral. Objetivos. Primera fase, el objetivo general es describir las características sociodemográficas de la muestra de estudio, como específicos son: analizar la relación entre nivel de sobrecarga del cuidador y las variables sociodemográficas de los cuidadores principales, analizar la relación entre nivel de sobrecarga del cuidador y las características clínicas del paciente. Segunda fase, determinar la eficacia de la intervención de la enfermera en círculos de diálogo, para reducir el nivel de sobrecarga percibido por los cuidadores principales de pacientes identificados como paciente crónico complejo y enfermedad crónica avanzada. Como específicos son: comparar el nivel de sobrecarga percibido por los cuidadores principales antes y después de la intervención entre el grupo experimental y el grupo control, y grado de satisfacción sobre la intervención enfermera círculos de diálogos. Metodología. Estudio cuantitativo en dos fases. Primera, estudio descriptivo transversal y segunda, un estudio experimental, ensayo clínico aleatorizado con enmascaramiento simple. El estudio se realizará en Cataluña, en las poblaciones del área metropolitana de Barcelona pertenecientes al Servicio de Atención Primaria Baix Llobregat Centre

Nursing Intervention to Improve Positive Mental Health and Self-Care Skills in People with Chronic Physical Health Conditions

The exponential increase in the number of people suffering chronic illness has become a problem for which healthcare services need a response. The inclusion of self-care and positive mental health as part of a strategy to promote health offers an opportunity for a reorganization oriented towards community spaces and group interventions. This study undertook the assessment of an intervention designed to optimize the agency of and capacity for self-care and positive mental health by utilizing activities drawn from the Nursing Intervention Classification (NIC), specifically from Field 3 (Behavioral), and organized as a program called PIPsE. A quasi-experimental design was prepared with an intervention group (n = 22) and a control group (n = 22), in a primary care center in the Barcelona metropolitan area. The instruments used were two ad hoc questionnaires to collect sociodemographic and satisfaction information and two scales: the Appraisal of Self-care Agency Scale (ASA) and the Positive Mental Health Questionnaire (PMHQ). The results obtained showed a significant increase in self-care capacity and both overall positive mental health and mental health by factors in the intervention group

Ética y ciudadanía - HU316 201801

Descripción: Ética y Ciudadanía es un curso de formación general, de carácter teórico-práctico, dirigido a estudiantes de ciclos iniciales de distintas carreras; que busca contribuir al desarrollo una de las competencias generales de nuestro modelo educativo: Ciudadanía en el nivel 1. Propósito: El curso pretende contribuir con el aprendizaje ético y ciudadano de los estudiantes invitándolos a conocer y explicar problemas éticos y de su vida cotidiana. Teniendo en cuenta que este curso se realiza bajo la modalidad semipresencial, se proponen diversas actividades educativas de tipo individual y grupal, tanto en las sesiones presenciales como en las sesiones virtuales, lo que supone una participación activa, organizada y permanente por parte de los estudiantes. Las estrategias a utilizarse incluyen: lectura y discusión de textos, análisis y evaluación de películas y documentales, resolución de casos, debates y exposiciones, foros virtuales. Siendo el docente la pieza clave para este proceso de aprendizaje, cumple con el rol de promover un ambiente colaborativo a través del diálogo, el respeto y la reflexión, partiendo del conocimiento previo y las fortalezas de los estudiantes para generar nuevas capacidades y desarrollar la competencia asociada al curso