Institute of Research and Innovation Parc Tauli

Metabolomic studies in COPD reveal systemic metabolic perturbations, yet sex is often treated as a covariate rather than a biological driver. We aimed to identify plasma metabolites differentiating COPD from controls and to define sex-specific metabolic signatures in both groups. Methods: In this controlled observational study (BIOMEPOC cohort), untargeted plasma metabolomics was performed by LC-MS/MS. Differential abundance was tested across four contrasts (COPD vs. controls; men vs. women within controls; men vs. women within COPD; sex-by-disease interaction) with a false discovery rate (FDR) correction. Because smoking history differed between COPD and controls, a post hoc ever-smokers analysis was conducted. Results: COPD differed from controls in nine metabolites (all decreased): DL-stachydrine, 3-methyl-L-histidine, fructose, pipecolinic and nipecotic acids, 5-nitro-o-toluidine, conjugated linoleic acid, aminoadipate, and creatinine. This pattern is compatible with metabolic depletion, remodeling, and/or altered flux across multiple compartments rather than simple substrate deficiency, spanning muscle-related pools, amino acid handling, carbohydrate-associated metabolism, and exposome-linked inputs. In ever-smokers, results were directionally consistent, with five metabolites remaining nominally significant. Among controls, five metabolites were higher in men after FDR correction (PABA, cis-4-hydroxy-D-proline, N-acetylasparagine, deoxycarnitine, and creatinine), consistent with physiological sex dimorphism in energy pathways, connective-tissue remodeling, and diet/microbiome-related metabolism. Within COPD, six metabolites differed by sex after FDR correction, defining three axes: creatine energy buffering (men: higher GAA/creatinine, lower creatine), purine/urate handling (men: higher urate), and conjugated bile acids (men: higher GCDCA), implicating muscle bioenergetics, redox/inflammatory tone, and gut-liver crosstalk. Conclusions: Plasma metabolomics identifies a pattern compatible with systemic remodeling in COPD and sex-associated divergences in creatine, purine/urate, and bile-acid pathways, supporting a sex-influenced view of systemic COPD heterogeneity and highlighting targets for mechanistic validation.

Pediatric cholecystitis and cholelithiasis management is heterogeneous. We surveyed European centers to map current practices, training exposure, and outcomes of pediatric biliary cholecystectomy. A 24-item cross-sectional international survey was developed by the European Union of Medical Specialists (UEMS) Section of Paediatric Surgery and distributed to centers in 31 UEMS member states. Items covered institutional resources, indications and timing, surgical approach and adjuncts (ERCP, ICG), training exposure, and center-level outcomes; results are reported as n (%), median (IQR). Outcomes were reported at the center level and were self-reported by participating institutions. Thirty-two centers from 23/31 states responded (74.2%). Pediatric surgeons were primary operators in 84% (shared with adult surgeons in 16%); ERCP access was 66%. Trainee operator share was 22.5% (IQR 5-50) and simulator access 56%. ICG cholangiography was routine in 12.5% and selective in 31%. Acute calculous cholecystitis: 6% always index-admission and 59.4% interval (29-41 days) cholecystectomy; post-ERCP choledocholithiasis: 16% always index-admission cholecystectomy. In 2023, 185 cases were reported: 98.9% laparoscopic with 1.6% conversion; median age 14 years (IQR 12.25-15), operative time 90min (IQR 60-110), length of stay 2 days (IQR 1-2); 10 complications (5.4%). Substantial heterogeneity persists in both care pathways and training exposure; most centers lack formal pediatric-specific guidelines, and trainee-led operating remains limited, supporting the need for evidence-based protocols and structured training pathways.

<h3>Background and Importance</h3> Serotonin syndrome (SS) is a rare but potentially life-threatening condition caused by excessive serotonergic activity, usually triggered by drug interactions; in renal insufficiency, drugs and metabolite accumulation may exacerbate it. Diagnosis in older patients is especially challenging, as atypical presentations and cognitive impairment can obscure recognition. Hospital pharmacists play a decisive role by identifying drug-related risks, supporting early diagnosis, and guiding therapy. <h3>Aim and Objectives</h3> To present the case of a 78-year-old man with stage 5 chronic kidney disease on haemodialysis and multimorbidity (diabetes mellitus with microangiopathy and recurrent foot infections, epilepsy on levetiracetam, ischaemic heart disease, prior gastrointestinal bleeding and chronic anaemia) and polypharmacy, admitted following a recent course of antibiotics. The patient had experienced previous episodes of transient neurological symptoms with negative stroke workup and levetiracetam adjustment. <h3>Material and Methods</h3> On admission, he presented with slurred speech and aphasia, without fever or trauma. Initial cranial CT excluded acute stroke, and levetiracetam dose was decreased (500 mg/48h) as it can cause lethargy. Within 24h, he deteriorated to stupor (Glasgow Coma Scale 4), responding only to painful stimuli, with generalised rigidity. Repeat CT again excluded acute pathology. Differential diagnosis included seizure, metabolic encephalopathy, drug-induced toxicity, and infection. Laboratory tests revealed hyperkalaemia (8.6 mmol/L), elevated lactate (73 mg/dL), leukocytosis (13.24 ×10⁹/L), and normal creatin kinase (54 U/L). Medication review revealed concurrent treatment with linezolid, sertraline and fentanyl. Naloxone was ineffective, prompting discontinuation of linezolid, sertraline, and fentanyl; raising suspicion of SS. <h3>Results</h3> Following discontinuation of serotonergic agents, the patient progressively improved, regaining consciousness, verbal responsiveness, and mobility within 48h. Other diagnoses were excluded, and SS was diagnosed clinically as an exclusion, supported by recovery after drug withdrawal. <h3>Conclusion and Relevance</h3> This case illustrates the complexity of diagnosing SS in elderly patients, where nonspecific symptoms, multimorbidity, and cognitive impairment hinder early recognition. Polypharmacy and altered pharmacokinetics increase vulnerability to drug interactions. Medication reviewed by hospital pharmacists is decisive for establishing the diagnosis and achieving recovery. Early recognition and prompt withdrawal of causative drugs are essential to prevent complications and reduce morbidity and mortality. Increased awareness among clinicians and hospital pharmacists is crucial to improve safety and prevent SS in this vulnerable population. <h3>Conflict of Interest</h3> No conflict of interest

Background: Bariatric surgery effectively treats severe obesity, but postoperative weight loss includes reductions in both fat mass (FM) and fat-free mass (FFM). Excessive FFM loss may increase the risk of sarcopenia, frailty, and long-term weight regain, yet its magnitude and determinants are not fully established. Methods: We conducted a retrospective analysis of a prospectively collected cohort of 179 patients who underwent laparoscopic or robotic Roux-en-Y gastric bypass between January 2020 and December 2022. Anthropometric parameters and body composition (bioelectrical impedance analysis) were measured preoperatively and at 6 and 12 months. The proportion of FFM loss relative to total weight loss (%FFML/WL) was calculated, and excessive FFM loss was defined using published cut-offs (≥25%, ≥30%, and ≥35%). Predictors of FFM preservation were assessed through stepwise regression. Results: Baseline BMI was 44.1 ± 4.6 kg/m2, FM 54.6 ± 10.7 kg, and FFM 61.1 ± 11.9 kg. At 6 and 12 months, BMI decreased to 31.0 ± 4.2 and 28.8 ± 4.4 kg/m2, respectively; FM decreased to 35.6 ± 11.0 and 22.0 ± 10.0 kg; and FFM to 54.7 ± 9.5 and 50.1 ± 7.0 kg (all p < 0.001). Most FFM loss occurred within the first 6 months (mean − 6.4 kg). Median %FFML/WL was 26.4% at 6 months and 28.7% at 12 months. Excessive FFM loss affected 41–46% of patients (≥25%), 27–31% (≥30%), and 14% (≥35%). In multivariable analysis, FFM at 6 months was the only independent predictor of FFM at 12 months (p < 0.001). Conclusions: Bariatric surgery leads to substantial FM and FFM reductions, with nearly half of patients exceeding established %FFML/WL alert thresholds. Early postoperative body composition monitoring may help identify individuals at higher risk of FFM depletion and guide preventive strategies such as adequate protein intake and resistance training.

BackgroundThe global nursing shortage has become a critical issue, worsened by poor working conditions, demographic shifts, and the COVID‐19 pandemic. Understanding nursing students’ preferences and expectations is crucial for improving workforce retention, guiding decision‐making, and enhancing job satisfaction. This study aimed to explore nursing students’ preferences and expectations regarding working environment dimensions and analyze differences by gender and generation.MethodsA quantitative descriptive cross‐sectional study was conducted using an online survey targeting 1277 nursing students from Catalan universities between March 27 and June 26, 2023. Convenience sampling was applied. Preferences and expectations for all items were recorded on a scale from 0 (minimum) to 10 (maximum), and responses were regrouped into three categories: low (0–4), moderate (5–7), and high (8–10). Data analysis was conducted using R (version 4.3.0) under RStudio (version 2023.03.0). The Kolmogorov–Smirnov test confirmed non‐normal distribution of continuous variables. Comparisons by gender and generation were made using chi‐square tests, with significance set at p < 0.05. Cronbach’s alpha was used to assess internal consistency for the questionnaire items, confirming the reliability of the survey dimensions.ResultsA significant gap was found in high category (scores 8–10) between nursing students’ preferences, which exceeded 80% for all working environment dimension items and their expectations, which remained below 50% in all cases, indicating a noticeable disparity.ConclusionsThe study highlights a significant discrepancy between nursing students’ high preferences (> 80%) for working environment dimensions and their low expectations (< 50%) of achieving them. This gap suggests that improving work conditions and recognition could stabilize the nursing workforce.

We read with interest the article by Bobelyak and colleagues and the accompanying Editorial.However, we have serious concerns about the article's methodology and conclusions.The authors reported REMS-BMD measurements at the proximal femur in patients before and after hip arthroplasty and, based on minimal changes in BMD and variations observed with different anthropometric inputs, concluded that REMS-BMD is essentially derived from age, sex, and BMI rather than from ultrasound spectral data.This conclusion is not supported by the evidence provided, which highlight instead technical errors and misinterpretations of REMS operating principles, as detailed below.