- ItemOpen AccessDifferential systemic decellularization in vivo to study molecular changes in each vasculature layer in murine models of disease(Cell Press, 2023) Gallart Palau, Xavier Ramon; Lorca, Cristina; Mulet, Maria; Sánchez Milán, José Antonio; Lisa, Julia; Cam Ngan, SoFong; Iyappan, Ranjith; Katoueezadeh, Maryam; Serra, Aida; Kwan Sze, SiuVascular dysfunction underlies the onset and progression of many life-threatening diseases, highlighting the need for improved understanding of its molecular basis. Here, we present differential systemic decellularization in vivo (DISDIVO), a protocol that enables systemic and independent study of the molecular changes in each vasculature layer in murine models of disease. We describe steps for anesthesia, perfusion surgery, and exsanguination. We then detail detachment and collection of glycocalyx and decellularization and collection of both endothelial and smooth muscle cells. For complete details on the use and execution of this protocol, please refer to Serra et al., Gallart-Palau et al., and Vinaiphat et al.
- ItemOpen AccessGATEKEEPER's Strategy for the Multinational Large-Scale Piloting of an eHealth Platform: Tutorial on How to Identify Relevant Settings and Use Cases(JMIR Publications, 2023) Batlle Garcia, Jordi de; Benítez, Iván; Moncusí Moix, Anna; Androutsos, Odysseas; Barbastro, Rosana Angles; Antonini, Alessio; Arana, Eunate; Cabrera-Umpierrez, Maria Fernanda; Cea, Gloria; Dafoulas, George Ε.; Folkvord, Frans; Fullaondo, Ane; Giuliani, Francesco; Huang, Hsiao-Ling; Innominato, Pasquale F.; Kardas, Przemyslaw; Lou, Vivian W.Q.; Manios, Yannis; Matsangidou, Maria; Mercalli, Franco; Mokhtari, Mounir; Pagliara, Silvio; Schellong, Julia; Stieler, Lisa; Votis, Konstantinos; Currás, Paula; Arredondo, Maria Teresa; Posada, Jorge; Guillén, Sergio; Pecchia, Leandro; Barbé Illa, Ferran; Torres, Gerard; Fico, GiuseppeBackground: The World Health Organization’s strategy toward healthy aging fosters person-centered integrated care sustained by eHealth systems. However, there is a need for standardized frameworks or platforms accommodating and interconnecting multiple of these systems while ensuring secure, relevant, fair, trust-based data sharing and use. The H2020 project GATEKEEPER aims to implement and test an open-source, European, standard-based, interoperable, and secure framework serving broad populations of aging citizens with heterogeneous health needs. Objective: We aim to describe the rationale for the selection of an optimal group of settings for the multinational large-scale piloting of the GATEKEEPER platform. Methods: The selection of implementation sites and reference use cases (RUCs) was based on the adoption of a double stratification pyramid reflecting the overall health of target populations and the intensity of proposed interventions; the identification of a principles guiding implementation site selection; and the elaboration of guidelines for RUC selection, ensuring clinical relevance and scientific excellence while covering the whole spectrum of citizen complexities and intervention intensities. Results: Seven European countries were selected, covering Europe’s geographical and socioeconomic heterogeneity: Cyprus, Germany, Greece, Italy, Poland, Spain, and the United Kingdom. These were complemented by the following 3 Asian pilots: Hong Kong, Singapore, and Taiwan. Implementation sites consisted of local ecosystems, including health care organizations and partners from industry, civil society, academia, and government, prioritizing the highly rated European Innovation Partnership on Active and Healthy Aging reference sites. RUCs covered the whole spectrum of chronic diseases, citizen complexities, and intervention intensities while privileging clinical relevance and scientific rigor. These included lifestyle-related early detection and interventions, using artificial intelligence–based digital coaches to promote healthy lifestyle and delay the onset or worsening of chronic diseases in healthy citizens; chronic obstructive pulmonary disease and heart failure decompensations management, proposing integrated care management based on advanced wearable monitoring and machine learning (ML) to predict decompensations; management of glycemic status in diabetes mellitus, based on beat to beat monitoring and short-term ML-based prediction of glycemic dynamics; treatment decision support systems for Parkinson disease, continuously monitoring motor and nonmotor complications to trigger enhanced treatment strategies; primary and secondary stroke prevention, using a coaching app and educational simulations with virtual and augmented reality; management of multimorbid older patients or patients with cancer, exploring novel chronic care models based on digital coaching, and advanced monitoring and ML; high blood pressure management, with ML-based predictions based on different intensities of monitoring through self-managed apps; and COVID-19 management, with integrated management tools limiting physical contact among actors. Conclusions: This paper provides a methodology for selecting adequate settings for the large-scale piloting of eHealth frameworks and exemplifies with the decisions taken in GATEKEEPER the current views of the WHO and European Commission while moving forward toward a European Data Space.
- ItemOpen AccessFungal corneal abscess caused by Exophiala dermatitidis(Sociedad Española de Quimioterapia, 2023) Mormeneo Bayo, Saray; Bellés Bellés, Alba; Prats Sánchez, Iván; López González, Éric; Aramburu, Jesus; Bernet Sánchez, Albert; Garcia Gonzalez, MercedesLetter to the Editor
- ItemOpen AccessDiagnosis and Treatment of Sleep Apnea in Children: A Future Perspective Is Needed(MDPI, 2023) Solano Pérez, Esther; Coso, Carlota; Castillo García, María; Romero Peralta, Sofía; López Monzoni, Sonia; Laviña, Eduardo; Cano-Pumarega, Irene; Sánchez de la Torre, Manuel; García-Río, Francisco; Mediano, OlgaObstructive sleep apnea (OSA) in children is a prevalent, but still, today, underdiagnosed illness, which consists of repetitive episodes of upper airway obstruction during sleep with important repercussions for sleep quality. OSA has relevant consequences in the pediatric population, mainly in the metabolic, cardiovascular (CV), and neurological spheres. However, contrary to adults, advances in diagnostic and therapeutic management have been scarce in the last few years despite the increasing scientific evidence of the deleterious consequences of pediatric OSA. The problem of underdiagnosis and the lack of response to treatment in some groups make an update to the management of OSA in children necessary. Probably, the heterogeneity of OSA is not well represented by the classical clinical presentation and severity parameters (apnea/hypopnea index (AHI)), and new strategies are required. A specific and consensus definition should be established. Additionally, the role of simplified methods in the diagnosis algorithm should be considered. Finally, the search for new biomarkers for risk stratification is needed in this population. In conclusion, new paradigms based on personalized medicine should be implemented in this population.
- ItemOpen AccessTraumatic Brain Injury and Acute Kidney Injury-Outcomes and Associated Risk Factors(MDPI, 2022-12-05) Barea-Mendoza, Jesús Abelardo; Chico-Fernández, Mario; Quintana-Díaz, Manuel; Servià Goixart, Lluís; Fernández-Cuervo, Ana; Bringas-Bollada, María; Ballesteros Sanz, María Ángeles; García-Sáez, Íker; Pérez-Bárcena, Jon; Llompart-Pou, Juan AntonioOur objective was to analyze the contribution of acute kidney injury (AKI) to the mortality of isolated TBI patients and its associated risk factors. Observational, prospective and multicenter registry (RETRAUCI) methods were used, from March 2015 to December 2019. Isolated TBI was defined as abbreviated injury scale (AIS) ≥ 3 head with no additional score ≥ 3. A comparison of groups was conducted using the Wilcoxon test, chi-square test or Fisher's exact test, as appropriate. A multiple logistic regression analysis was conducted to analyze associated risk factors in the development of AKI. For the result, overall, 2964 (30.2%) had AIS head ≥ 3 with no other area with AIS ≥ 3. The mean age was 54.7 (SD 19.5) years, 76% were men, and the ground-level falls was 49.1%. The mean ISS was 18.4 (SD 8). The in-hospital mortality was 22.2%. Up to 310 patients (10.6%) developed AKI, which was associated with increased mortality (39% vs. 17%, adjusted OR 2.2). Associated risk factors (odds ratio (OR) (95% confidence interval)) were age (OR 1.02 (1.01-1.02)), hemodynamic instability (OR 2.87 to OR 5.83 (1.79-13.1)), rhabdomyolysis (OR 2.94 (1.69-5.11)), trauma-associated coagulopathy (OR 1.67 (1.05-2.66)) and transfusion of packed red-blood-cell concentrates (OR 1.76 (1.12-2.76)). In conclusion, AKI occurred in 10.6% of isolated TBI patients and was associated with increased mortality.