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One of the main challenges in ultrafast material science is to trigger phase transitions with short pulses of light. Here we show how strain waves, launched by electronic and structural precursor phenomena, determine a coherent macroscopic transformation pathway for the semiconducting-to-metal transition in bistable Ti 3 O 5 nanocrystals. Employing femtosecond powder X-ray diffraction, we measure the lattice deformation in the phase transition as a function of time. We monitor the early intra-cell distortion around the light absorbing metal dimer and the long range deformations governed by acoustic waves propagating from the laser-exposed Ti 3 O 5 surface. We developed a simplified elastic model demonstrating that picosecond switching in nanocrystals happens concomitantly with the propagating acoustic wavefront, several decades faster than thermal processes governed by heat diffusion. Ultrafast control of materials draws interest. Here, the authors extend X-ray powder diffraction to the femtosecond timescale to follow the photo-induced semiconductor to metal transition in titanium pentaoxide, observing a phase front that moves at the speed of sound and proposing a little explored mechanism.

Background To assess mortality rate (MR) and standardized mortality rate (SMR) of rheumatoid arthritis-related interstitial lung disease (RA-ILD) patients and to evaluate the role of radiographic patterns in mortality. Methods A longitudinal multicentric study was conducted in RA-ILD patients from 2005 to 2015 and followed-up until October 2018 in Madrid. Patients were included in the Neumologia-Reumatología y Enfermedades Autoinmunes Registry, from diagnosis of ILD. The main outcome was all-cause mortality. The radiographic pattern at baseline [usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), or others] was the independent variable. Covariables included sociodemographic and clinical data. Survival techniques were used to estimate MR, expressed per 1000 persons-year with their 95% confidence intervals [CI]. Cox multiple regression model was run to examine the influence of radiographic patterns on survival. SMR [CI] was calculated comparing MR obtained with MR expected in the general population of Madrid by indirect age-gender standardization. Results 47 patients were included with a follow-up 242 patients-year. There were 16 (34%) deaths, and most frequent causes were acute ILD exacerbation and pneumonia. MR was 64.3 [39.4–104.9], and 50% of the patients died at 8.3 years from ILD diagnosis. After adjusting for confounders, (UIP compared to NSIP was associated with higher mortality risk. The overall SMR was 2.57 [1.4–4.17]. Women of 60–75 years of age were the group with the highest SMR. Conclusions RA-ILD is associated with an excess of mortality compared to general population. Our results support that UIP increases the risk of mortality in RA-ILD, regardless other factors.

This study aimed to investigate the effectiveness of mindfulness-based cognitive therapy (MBCT) as a complementary approach in patients with bulimia nervosa (BN) or binge eating disorder (BED), and to assess how the reduction of the cognitive load of words related to eating disorders (ED) could constitute an intermediate factor explaining its global efficacy. Eighty-eight women and men participated in clinical assessments upon inscription, prior to and following 8-week group MBCT. Mindfulness skills were assessed using the five facet mindfulness questionnaire; eating behaviors were assessed using the Three Factor Eating Questionnaire (TFEQ); comorbid pathologies were assessed using the beck depression index and the state-trait anxiety inventory. The cognitive load of words associated with ED was assessed through a modified version of the Stroop color naming task. Mindfulness skills improved significantly (p < .05) after group MBCT. The improvement of TFEQ scores was accompanied by reduced levels of depressive mood and trait anxiety. The positive impact of MBCT on TFEQ score was directly related to an improvement of the performance in the Stroop task. MBCT represents an interesting complementary therapy for patients with either BN or BED, at least when cognitive and behavioral domains are concerned. Such efficacy seems to be mediated by the reduction of the cognitive load associated with ED stimuli, which offers a possible explanation of how MBCT could reduce binge-eating behaviors. Other studies are needed, in independent centers, to focus more directly on core symptoms and long-term outcome.

To examine intensive care nurses’ main concerns in respect of ethical practice, and to investigate how nurses continue to practise in an ethical way despite challenges in order to offer a conceptualisation of moral resilience. This qualitative study followed Glaser and Strauss’ version of grounded theory. The study was reviewed, and approved, by research ethics committees in Switzerland and in England. Data consisted of field notes and in-depth interviews with 16 nurses working in intensive care in Switzerland and memos developed during the analysis. Data analysis followed the constant comparative method. This study took place between 2014 and 2017. This study identified new understanding in how intensive care nurses manage their concerns and challenges regarding moral practice. The main category for moral resilience is harmonising connectedness, which represents intensive care nurses’ main concern with regard to their moral life, and at the same time, represents the pattern of behaviour in their social interactions and what they yearn for. This study offers new insight into intensive care nurses’ moral practice, moral resilience and strategies nurses use to achieve moral wellbeing.

Background: A study was undertaken to evaluate exacerbations and their impact on the health related quality of life (HRQL) of patients with chronic obstructive pulmonary disease (COPD). Methods: A 2 year follow up study was performed in 336 patients with COPD of mean (SD) age 66 (8.2) years and mean (SD) forced expiratory volume in 1 second (FEV1) 33 (8)% predicted. Spirometric tests, questions regarding exacerbations of COPD, and HRQL measurements (St George’s Respiratory Questionnaire (SGRQ) and SF-12 Health Survey) were conducted at 6 month intervals. Results: A total of 1015 exacerbations were recorded, and 103 (30.7%) patients required at least one hospital admission during the study. After adjustment for baseline characteristics and season of assessment, frequent exacerbations had a negative effect on HRQL in patients with moderate COPD (FEV1 35–50% predicted); the change in SGRQ total score of moderate patients with ⩾3 exacerbations was almost two points per year greater (worse) than those with <3 exacerbations during the follow up (p = 0.042). For patients with severe COPD (FEV1 <35% predicted) exacerbations had no effect on HRQL. The change in SGRQ total score of patients admitted to hospital was almost 2 points per year greater (worse) than patients not admitted, but this effect failed to show statistical significance in any severity group. There was a significant and independent seasonal effect on HRQL since SGRQ total scores were, on average, 3 points better in measurements performed in spring/summer than in those measured in the winter (p<0.001). Conclusions: Frequent exacerbations significantly impair HRQL of patients with moderate COPD. A significant and independent effect of seasonality was also observed.

Background and aims The role of overweight and obesity in the development of atrial fibrillation (AF) is well established; however, the differential effect on the occurrence and recurrence of AF remains uncertain. The aim of this review is to compare the effect of underweight and varying degrees of obesity on onset of AF and in recurrent post-ablation AF, and, when possible, in relation to sex. Methods A systematic literature search was conducted in PubMed, Embase, and Cochrane Library from inception to January 31, 2023. Studies reporting frequency of newly-diagnosed AF and of recurrent post-ablation AF in different BMI categories, were included. 3400 records were screened and 50 met the inclusion criteria. Standardized data search and abstraction were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement. Data were extracted from the manuscripts and were analyzed using a random effect model. The outcome was the occurrence of AF in population studies and in patients undergoing ablation. Results Data from 50 studies were collected, of which 27 for newly-diagnosed AF and 23 for recurrent post-ablation AF, for a total of 15,134,939 patients, of which 15,115,181 in studies on newly-diagnosed AF and 19,758 in studies on recurrent post-ablation AF. Compared to normal weight, the increase in AF was significant ( p  < 0.01) for overweight, obese, and morbidly obese patients for newly-diagnosed AF, and for obese and morbidly obese patients for recurrent post-ablation AF. Newly-diagnosed AF was more frequent in obese female than obese male patients. Conclusion The effect of increased BMI was greater on the onset of AF, and obese women were more affected than men.

Background:The Sydney criteria were the classification criteria for antiphospholipid syndrome (APS) used until 2023. They included a clinical domain (vascular thrombosis or pregnancy morbidity) and an analytical domain (positivity of anticardiolipin antibodies [aCL], anti-beta2 glycoprotein [aB2GP1] and lupus anticoagulant [AL]). However, multiple studies have shown that there is large clinical and analytical variability within these patients. With the objective of better classifying these patients, in 2023 the American College of Rheumatology (ACR)/ Alliance of Associations for Rheumatology (EULAR) published the new APS classification criteria. These included other clinical criteria, previously called non-criteria manifestations, which include microvascular, haematological or cardiac manifestations, previously considered less frequent or atypical.Objectives:To analyse whether the non-criteria manifestations differ in frequency between triple positive APS (APS-TP) and non-triple positive APS patients (nTP-APS). To compare the cardiac manifestations between patients with APS-TP and APS-nTP.Methods:Observational transversal study with a cohort of patients from a tertiary care hospital. Patients needed to have a diagnosis of APS and any of the clinical manifestations included in the new ACR/ EULAR classification of 2023. Sociodemographic, clinical and analytical (aCL, aB2GP1 and AL) variables were analysed.Results:A total of 101 patients were included. The majority of patients were female (n=62, 61.4%), and the mean age was 53 years (Figure 1). Regarding baseline characteristics, Systemic Lupus Erythematosus (SLE) was significantly more frequent in patients APS-TP (p=0.025). Clinically, 22 patients (21.8%) presented obstetric manifestations and 66 (65.3%) thrombotic manifestations (25 [37.9%] arterial, 36 [54.5%] venous and 5 [7.6%] arterial and venous). There were 6 [5.9%] with catastrophic APS. Regarding the non-criteria manifestations, given their wide heterogeneity, they are summarized in Figure 2. When analysing the differences in the presence of non-criteria manifestations between patients with APS-TP and APS-nTP, cardiac manifestations were significantly more frequent in APS-TP patients (p=0.013), particularly valvular disease (Figure 2). We also studied the presence of catastrophic APS in relation to triple positivity, and it was observed that it was more prevalent in patients with APS-TP (n= 5 [11.1%] VS 1 [1.8%]), although without statistical significance. Regarding cardiac manifestations, we focused mainly on valvular heart disease given that other manifestations were found to be infrequent (Figure 2). Of the 101 patients analysed, 23 (22.8%) had valve disease, of which 15 [33.3%] were APS-TP compared to 8 [14.3%] that were APS-nTP (p = 0.023). Valvular regurgitation was more common than stenosis (n= 21 [20.8%] VS 6 [5.9%], respectively) and the mitral valve was the most affected valve in both groups (n= 17 [16.8%]).Conclusion:In our cohort, patients with APS-TP presented significantly more cardiac manifestations, particularly valvular disease. We did not find differences in the rest of the non-criteria manifestations. No clinical manifestation was found to be more frequent in patients with APS-nTP. In both groups, valve insufficiency was more common than stenosis and the mitral valve was the most affected. Finally, we observed a higher presence of SLE in patients with APS-TP. In this context, a subanalysis of the presence of valvular disease according to TP and co-diagnosis of SLE was performed, and we did not find more presence of valvular disease in patients with APS secondary to SLE.REFERENCES:NIL.Acknowledgements:To Ivette and Judit.Disclosure of Interests:None declared.

Background:It is known that triple positive antiphospholipid syndrome (APS-TP) is related to an increased presence of thrombotic and obstetric manifestations. Triple positivity is referred by the concurrence of anticardiolipin antibodies, anti-beta2 glycoprotein I antibodies and lupus anticoagulant. Up until the definition of the new American College of Rheumatology (ACR)/ European Alliance of Associations for Rheumatology (EULAR) classification criteria, APS was only classified by a laboratory domain and a clinical domain including thrombotic or obstetric events. The addition of other clinical manifestations called “non-criteria” will allow a greater number of patients to be early and systematically detected.Objectives:To determine the prevalence of the new clinical manifestations included in the 2023 ACR/EULAR classification for APS-TP patients. To analyze the prevalence of “non-criteria” manifestations in the absence of thrombotic or obstetric events in patients with APS-TP.Methods:Cross-sectional descriptive study was carried out in a tertiary care hospital. APS-TP patients diagnosed between 1990 and 2023 were included. Patients under 18 years of age were excluded. Patients were classified into two groups: APS-TP with the presence of thrombotic and/or obstetric events (APS-TP1) and APS-TP with neither thrombotic nor obstetric events but with the presence of a non-criteria manifestation (APS-TP2). Sociodemographic, clinical and analytical variables were collected from both groups.Results:A total of 51 APS-TP patients were identified, 36 (70.6%) APS-TP1 patients and 15 (29.4%) APS-TP2 patients. The majority of patients were female (59.3%) with a mean age of diagnosis of 47.2 years (Figure 1). Only 5 patients (9.8%) were classified as catastrophic APS. In the APS-TP1 group, 34 patients (66.7%) presented thrombosis (venous: 20 [58.8%], arterial 12 [35.2%] and both 4 [11.8%]) and 7 patients (13.7%) presented obstetric events. The most frequent ‘non-criteria’ manifestation in the APS-TP1 group was thrombocytopenia (36.1%), while in the APS-TP2 group was valvular heart disease (46.1%) followed by Raynaud’s phenomenon (33.3%). There were no significant differences in any of the observed variables (Figure 2).Conclusion:In our cohort, the most common clinical manifestation overall was thrombosis. In patients without either thrombosis or obstetric events, the most prevalent manifestations were valvular heart disease and Raynaud’s phenomenon. The importance of studying antiphospholipid syndrome in patients with non-thrombotic manifestations is rising, especially in patients who do not meet criteria for other connective tissue diseases. Although some manifestations were exclusive to the thrombotic or obstetric morbidity group (renal microangiopathy, alveolar hemorrhage, bilateral adrenal hemorrhage), we did not find significant differences. This may be influenced by the small sample size, so it could be considered as a further object of study.REFERENCES:NIL.Acknowledgements:To Judit and Ivette.Disclosure of Interests:None declared.

The Warburg effect in cancer cells has been proposed to involve several mechanisms, including adaptation to hypoxia, oncogenes activation or loss of oncosuppressors and impaired mitochondrial function. In previous papers, it has been shown that K- ras transformed mouse cells are much more sensitive as compared with normal cells to glucose withdrawal (undergoing apoptosis) and present a high glycolytic rate and a strong reduction of mitochondrial complex I. Recent observations suggest that transformed cells have a derangement in the cyclic adenosine monophosphate/cAMP-dependent protein kinase (cAMP/PKA) pathway, which is known to regulate several mitochondrial functions. Herein, the derangement of the cAMP/PKA pathway and its impact on transformation-linked changes of mitochondrial functions is investigated. Exogenous stimulation of PKA activity, achieved by forskolin treatment, protected K-ras-transformed cells from apoptosis induced by glucose deprivation, enhanced complex I activity, intracellular adenosine triphosphate (ATP) levels, mitochondrial fusion and decreased intracellular reactive oxygen species (ROS) levels. Several of these effects were almost completely prevented by inhibiting the PKA activity. Short-time treatment with compounds favoring mitochondrial fusion strongly decreased the cellular ROS levels especially in transformed cells. These findings support the notion that glucose shortage-induced apoptosis, specific of K-ras-transformed cells, is associated to a derangement of PKA signaling that leads to mitochondrial complex I decrease, reduction of ATP formation, prevalence of mitochondrial fission over fusion, and thereby opening new approaches for development of anticancer drugs.

The presence of potentially toxic elements (PTEs) may hinder a more widespread application of biosolids in agriculture. At present, the European Directive 86/278/CEE limit the total concentrations of seven metals (Cu, Cr, Ni, Pb, Zn, Cd and Hg) in agricultural soils and in sewage sludges used as fertilizers but it has not taken into consideration the potential impacts of other emerging micropollutants that may be present in the biosolids as well as their mobility. The aim of this study was to evaluate the accumulation and mobility of 13 elements (including regulated metals and other inorganic species) in agricultural soils repeatedly amended with biosolids for 15 years. Firstly, three digestions programs using different acid mixtures were tested to evaluate the most accurate and efficient method for analysis of soil and sludge. Results demonstrated that sewage sludge application increased concentrations of Pb and Hg in soil, but values did not exceed the quality standard established by legislation. In addition, other elements (As, Co, Sb, Ag, Se and Mn) that at present are not regulated by the Spanish and European directives were identified in the sewage sludge, and significant differences were found between Ag content in soils amended with biosolids in comparison with control soils. This fact can be related to the increasing use of silver nanoparticles in consumer products due to their antibacterial properties. Results from the leaching tests show up that, in general, the mobility degree for both regulated and non-regulated elements in soils amended with biosolids was quite low (<10 %).