Anthropogenic impacts on threatened species erode functional diversity in chelonians and crocodilians.

The Anthropocene is tightly associated with a drastic loss of species worldwide and the disappearance of their key ecosystem functions. The orders Testudines (turtles and tortoises) and Crocodilia (crocodiles, alligators, and gharials) contain numerous threatened, long-lived species for which the functional diversity and potential erosion by anthropogenic impacts remains unknown. Here, we examine 259 (69%) of the existing 375 species of Testudines and Crocodilia, quantifying their life history strategies (i.e., trade-offs in survival, development, and reproduction) from open-access data on demography, ancestry, and threats. We find that the loss of functional diversity in simulated extinction scenarios of threatened species is greater than expected by chance. Moreover, the effects of unsustainable local consumption, diseases, and pollution are associated with life history strategies. In contrast, climate change, habitat disturbance, and global trade affect species independent of their life history strategy. Importantly, the loss of functional diversity for threatened species by habitat degradation is twice that for all other threats. Our findings highlight the importance of conservation programmes focused on preserving the functional diversity of life history strategies jointly with the phylogenetic representativity of these highly threatened groups.

Assessing DESS solution for the long-term preservation of nematodes from faecal samples.

Preservation of biological samples is a relevant issue for many scientific disciplines. Although traditional preservers, such as formaldehyde or ethanol, imply major disadvantages related to health risks, DNA degradation and distortion of structures, they are widely used. Hence, the search for viable alternatives preserving morphometry and genetics seems necessary. Here we assess the suitability of DESS solution to preserve adult nematodes and their eggs in faeces. Concretely, faecal samples of terrestrial tortoises with oxyurids were used to: (i) compare the 1-month storage efficacy of eggs from different conservation protocols (faeces without preserver at -20 °C, faeces with DESS solution at room temperature, faeces with DESS solution at -20 °C and faeces with ethanol 70% at room temperature); (ii) address morphological nematode identification after 2 years of storage with DESS. We also corroborated that nematode DNA remained viable after 2 years. Overall, our results showed that DESS solution at room temperature is an advisable alternative to conserve both parasite eggs and adult nematodes for morphological identification and genetic purposes. It also offers the advantages of being low-cost, safe and suitable for fieldwork conditions and shipments without refrigeration for nematode preservation.

Predation impact on threatened spur-thighed tortoises by golden eagles when main prey is scarce.

A reduction in adult survival in long-living species may compromise population growth rates. The spur-thighed tortoise (Testudo graeca) is a long-lived reptile that is threatened by habitat loss and fragmentation. Golden eagles (Aquila chrysaetos), whose breeding habitats overlap that of tortoises, may predate them by dropping them onto rocks and breaking their carapaces. In SE Spain, the number of golden eagles has increased in the last decades and the abundance of their main prey (i.e., rabbits Oryctolagus cuniculus) has decreased. Our aims were to 1) describe the role of tortoises in golden eagles' diet, and 2) estimate the predation impact of golden eagles on tortoises in eagles' territories and in the regional tortoise population. We collected regurgitated pellets and prey remains under eagle nests and roosts, and obtained information on tortoise abundance and population structure and rabbit abundance. We found that tortoises were an alternative prey to rabbits, so that eagles shifted to the former where the latter were scarce. The average predation rate on tortoises was very low at the two studied scales. However, eagles showed a marked selection for adult female tortoises, which led the tortoise sex ratio to be biased towards males in those eagle territories with higher tortoise predation. Whether this may compromise the spur-thighed tortoise long-term population viability locally deserves further attention.

[Prevalence of SARS-CoV-2 infection during the first wave of the pandemic among health and non-health personnel of the General Hospital of Segovia, Castilla y León]. / Prevalencia de infección por SARS-CoV-2 durante la primera oleada de la pandemia entre personal sanitario y no sanitario del Hospital General de Segovia, Castilla y León.

OBJECTIVE: Health and non-health workers (HNH-W) in a hospital are more exposed to SARS-CoV-2 infection than the general population. We studied the prevalence of this infection in these workers of Segovia´s Hospital after the first epidemic wave. METHODS: Monocentric, observational, cross-sectional study, carried out between April 29 and May 14, 2020. The infection was diagnosed by capillary immunochromatography test for IgG and / or IgM antibodies, or PCR. Work, health, and exposure variables were studied. RESULTS: A total of 1,335 HNH-W participated in the study out of a total of 1,667 (80.1%), 79.3% women, with a mean age of 47.3 years, and 47.1 for men. The prevalence of infected was 21.95%, 24.7% asymptomatic. Age presented a significant OR of 1.02/year. Exposure outside of work increased the prevalence by 16.8%. The continued use of Personal Protective Equipment (PPE) and the administration of nebulizations presented an OR of 0.54 and 0.46 respectively. The symptoms associated with the highest prevalence were anosmia (OR 9.31), ageusia (OR 3.05), and fever (OR 1.94). Today, about 75% of HNH-W were infected in the first wave. CONCLUSIONS: The prevalence is higher among healthcare workers than the population they serve. Age is associated with a higher prevalence of infection. Almost a quarter of those infected were asymptomatic. The continuous use of PPE was associated with a lower prevalence, for that the administration of nebulisations could be safe. The symptoms with the greatest association were fever, anosmia, and ageusia.

Prevalence and risk factors for acute stress disorder in female victims of sexual assault.

Sexual assault is one of the most traumatic events a person can experience. Despite this, information regarding the risk factors associated with the development of Acute Stress Disorder (ASD) in sexual assault victims is scarce. A follow-up prospective cohort study was designed to examine the prevalence and risk factors of ASD in women exposed to a recent sexual assault. A total of 156 women were treated at the Emergency Department of a university general hospital shortly after sexual assault. Sociodemographic, clinical and sexual assault-related variables were collected. The Acute Stress Disorder Interview was used to estimate the prevalence of ASD at three weeks post-SA. From the 156 victims, 66.6% (N = 104) met ASD diagnosis using DSM-5 criteria, whereas 59.6% (N = 93) met ASD diagnosis using DSM-IV criteria. The risk factors associated with the development of ASD were nationality, psychiatric history, peritraumatic dissociation and type of assault. In conclusion, the prevalence of ASD in female victims of recent sexual assault was high, affecting approximately two thirds of them. The recognition of the risk factors associated with ASD development, like peritraumatic dissociation or type of assault, may aid in the prompt detection of vulnerable women that require early and specific interventions shortly after trauma.

Transbronchial biopsy in chronic hypersensitivity pneumonitis.

INTRODUCTION: The diagnosis of chronic hypersensitivity pneumonitis (CHP) is based on relevant exposure, tomographic findings and, in some cases, pathological data. The role of bronchoscopy is uncertain, especially in the fibrotic form of CHP. AIM: To analyze the yield of transbronchial biopsy (TBBx) in patients with CHP according to tomographic findings and to evaluate the importance of bronchoalveolar lavage (BAL) in the diagnostic approach. METHODS: This retrospective study analyzed patients with CHP who underwent TBBx in São Paulo, Brazil. The TBBx findings were classified as characteristic (granulomas and/or multinucleated giant cells, associated or not with peribronchiolar infiltration of lymphocytes and plasma cells and bronchiolocentric distribution) and supportive (data indicative of small airway injury: peribronchiolar metaplasia, organizing pneumonia, and intra-alveolar foamy macrophages). RESULTS: One hundred nine patients were included. The presence of characteristic findings of HP was seen in 16 patients (14.7%), and supportive findings were seen in 32 patients (29.4%), with a total yield of 44%. Pathological characteristic findings were more common in cases without fibrosis on high-resolution computed tomography (HRCT) (27.3% vs. 9.2%, p= 0.014), whereas the presence of supportive findings was more common in fibrotic HP (38.1% vs. 9.1%, p= 0.002). Fifty-two patients had differential cytology in BAL fluid. Lymphocytosis (> 20%) was present in 51.9% of the patients. There was no difference in the median lymphocyte count according to nonfibrotic and fibrotic tomographic findings on HRCT. CONCLUSION: TBBx and BAL fluid cytology have a role in CHP diagnosis.

[Safe surgery and COVID-19: A narrative review]. / Cirugía segura y COVID-19: una revisión narrativa.

BACKGROUND: The interruption of surgical care in Spain caused by the pandemic must end. Recovery from this activity must be carried out on an elective basis and in conjunction with possible cases of COVID-19. The objective of this review was to incorporate good practice criteria related to COVID-19 into the context of safe surgery, which would make it possible to develop a proposed surgical safety checklist adapted to patients with this disease. METHODS: Narrative literature review, following the PRISMA protocol, in the Medline and Cochrane directories, using the MeSH terms (coronavirus, infections, safety, surgical procedures, operative, checklist) and the Boolean operator AND. In addition, recommendations from scientific bodies and societies were reviewed (grey literature). RESULTS: Thirty-three final studies were included with recommendations for safe surgery and surgical safety checklist adapted for COVID-19, the most frequent being aspects related to treatment (41.3%) and prevention and control measures (27.6%). CONCLUSIONS: The existence of a broad consensus on good practices recommended for COVID surgical patients makes it possible to make a proposal for surgical safety checklist to these patients.

Tricobezoar de estómago / Gastric Trichobezoar Rapunzel Syndrome

Trichobezoars are an unusual pathology that appears generally in young adolescents associated with psychiatric disorders. The clinical presentation is very varied. The diagnosis is suspected by the clinical records of teen agers with trichophagia and trichotillomania and the digestive disorders are confirmed by the results of the endoscopy, the same as with images toward the therapeutic management. Undowbtly the treatment is surgical, and continuation with the psychiatric treatment is essential to avoid a recidival of the disease. Bezoar is a concretion formed in the alimentary tract, and according to the substances forming the ball, we find trichobezoar (foodball). The Rapunzel syndrome is an unusual complication of individual bezoar. When the trichobezoar located in the stomach extends through the pylorus into the small intestine and the right colon, is known as Rapunzel syndrome, that is an extremely rare gastric condition in humans. It is a rare form of trichobezoar, occurring in psychiatric patients with the trichobezoar (hairball) located in the stomach. The syndrome is named after the long haired girl Rapunzel in the fairy tale of the brothers Grimm. Most bezoars in teen agers are trichobezoars from swallowed hair. A 28-year-old patient is presented, with abdominal pain and vomiting, on the general physical examination the patient revealed a severe weight loss. Later on, through a gastrostomy, appeared the trichobezoar, being removed with good postsurgical resullts

Identification and expression analysis of the Spodoptera exigua neuropeptidome under different physiological conditions.

Neuropeptides are small signalling molecules acting as neurohormones, neurotransmitters and neuromodulators. Being part of the chemical communication system between cells within an organism, they are involved in the regulation of different aspects of animal physiology and behaviour such as feeding, reproduction, development and locomotion. Transcriptomic data from larval and adult tissues have been obtained and mined to generate a comprehensive neuropeptidome for the polyphagous insect pest Spodoptera exigua. Sixty-three neuropeptides have been identified and described based on their tissue specificity and their regulation in response to different abiotic perturbations. Expression analyses have identified those neuropeptides involved in ingestive and digestive behaviour of S. exigua larvae and revealed a general pattern of upregulation in the midgut during larval starvation. Our results represent a comprehensive neuropeptidome of a lepidopteran species that will be highly relevant to future studies and provide novel information of the insect's perception of its environment.

Linking stable isotopes and biochemical responses in Balanus glandula under sewage influence.

In the present study, we analyzed the influence of untreated sewage exposure on carbon (δ13C) and nitrogen (δ15N) isotopic composition and several biochemical responses in the barnacle Balanus glandula. The main objective was to evaluate whether changes in stable isotopes signature do reflect biochemical sub-lethal effects in a sewage influence gradient. Stable isotopes analysis showed differences in isotope signatures between close sewage influence and distant sites, being δ13C signatures stronger than that of δ15N. Regarding biochemical effects, although organisms close to the effluent would be clearly exposed to contaminants (increased GST activity) the oxidative stress would not be too evident (peroxidases and ACAP not affected). The most affected physiological aspect was the digestive one, reflected in increased alkaline proteases and lipases activities. A clear relation between δ15N and GST activity was found, showing to δ15N as an indicator of potential exposure to chemical contaminants.

The combined use of tigecycline with high-dose colistin might not be associated with higher survival in critically ill patients with bacteraemia due to carbapenem-resistant Acinetobacter baumannii.

OBJECTIVE: To assess the association of survival and treatment with colistin and tigecycline in critically ill patients with carbapenem-resistant Acinetobacter baumannii bacteraemia. METHODS: An observational cohort study was carried out. Targeted therapy consisted of monotherapy with colistin (9 million UI/day) or combined therapy with colistin and tigecycline (100 g/day). The primary outcome was 30-day crude mortality. The association between combined targeted therapy and mortality was controlled for empirical therapy with colistin, propensity score of combined therapy and other potential confounding variables in a multivariate Cox regression analysis. RESULTS: A total of 118 cases were analysed. Seventy-six patients (64%) received monotherapy and 42 patients (36%) received combined therapy. The source of bacteraemia was primary in 18% (21/118) of the patients, ventilator-associated pneumonia in 64% (76/118) and other sources in 14% (16/118). The 30-day crude mortality rate was 62% (42/76) for monotherapy and 57% (24/42) for combined therapy. The variables associated with 30-day crude mortality were: Charlson index (hazard ratio (HR) 1.16, 95% CI 1.02-1.32; p 0.028), empirical therapy with colistin (HR 2.25, 95% CI 1.33-3.80; p 0.003) and renal dysfunction before treatment (HR 1.91, 95% CI 1.01-3.61; p 0.045). Combined targeted therapy was not associated with lower adjusted 30-day crude mortality (adjusted HR 1.29, 95% CI 0.64-2.58; p 0.494). CONCLUSIONS: Combined targeted therapy with high-dose colistin and standard dose tigecycline was not associated with lower crude mortality of bacteraemia due to carbapenem-resistant A. baumannii in critically ill patients. TRIAL REGISTRATION: Registered in ClinicalTrials.gov. Identifier: NCT02573064.

Next generation of ventricular catheters for hydrocephalus based on parametric designs.

BACKGROUND: The flow pattern of the cerebrospinal fluid is probably the most important factor related to obstruction of ventricular catheters during the normal treatment of hydrocephalus. To better comprehend the flow pattern, we have carried out a parametric study via numerical models of ventricular catheters. In previous studies, the flow was studied under steady and, recently, in pulsatile boundary conditions by means of computational fluid dynamics (CFD) in three-dimensional catheter models. OBJECTIVE: This study aimed to bring in prototype models of catheter CFD flow solutions as well to introduce the theory behind parametric development of ventricular catheters. METHODS: A preceding study allowed deriving basic principles which lead to designs with improved flow patterns of ventricular catheters. The parameters chosen were the number of drainage segments, the distances between them, the number and diameter of the holes on each segment, as well as their relative angular position. RESULTS: CFD results of previously unreleased models of ventricular catheter flow solutions are presented in this study. Parametric development guided new designs with better flow distribution while lowering the shear stress of the catheters holes. High-resolution 3D printed catheter solutions of three models and basic benchmark testing are introduced as well. CONCLUSIONS: The next generation of catheter with homogeneous flow patterns based on parametric designs may represent a step forward for the treatment of hydrocephalus, by possibly broadening their lifespan.

An internally validated new clinical and inflammation-based prognostic score for patients with advanced hepatocellular carcinoma treated with sorafenib.

BACKGROUND: Sorafenib is a standard treatment for patients (pts) with advanced hepatocellular carcinoma (aHCC), although the clinical benefit is heterogeneous between different pts groups. Among novel prognostic factors, a low baseline neutrophil-to-lymphocyte ratio (bNLR) and early-onset diarrhoea have been linked with a better prognosis. PURPOSE: To identify prognostic factors in pts with aHCC treated with 1st-line sorafenib and to develop a new prognostic score to guide management. MATERIALS AND METHODS: Retrospective review of 145 pts bNLR, overall toxicity, early toxicity rates and overall survival (OS) were assessed. Univariate and multivariate analysis of prognostic factors for OS was performed. The prognostic score was calculated from the coefficients found in the Cox analysis. ROC curves and pseudoR2 index were used for internal validation. Discrimination ability and calibration were tested by Harrel's c-index (HCI) and Akaike criteria (AIC). RESULTS: The optimal bNLR cut-off for the prediction of OS was 4 (AUC 0.62). Independent prognostic factors in multivariate analysis for OS were performance status (PS) (p < .0001), Child-Pugh (C-P) score (p = 0.005), early-onset diarrhoea (p = 0.006) and BNLR (0.011). The prognostic score based on these four variables was found efficient (HCI = 0.659; AIC = 1.180). Four risk groups for OS could be identified: a very low-risk (median OS = 48.6 months), a low-risk (median OS = 11.6 months), an intermediate-risk (median OS = 8.3 months) and a high-risk group (median OS = 4.4 months). CONCLUSIONS: PS and C-P score were the main prognostic factors for OS, followed by early-onset diarrhoea and bNLR. We identified four risk groups for OS depending on these parameters. This prognostic model could be useful for patient stratification, but an external validation is needed.

Parents' reading history as an indicator of risk for reading difficulties.

Children from families whose members have reading impairments are found to be poorer performers, take less advantage of instruction, and require more time to reach the reading level of children whose relatives are good readers. As a family's reading history may not be available, a self-report of reading abilities is used to identify children's background. In this paper, we explored the contribution of phonological, literacy, and linguistic abilities and reported parental reading abilities to predict reading achievement at the end of the school year in a Spanish sample. Children who were starting to read were assessed in a variety of oral language, phonological, and literacy tasks at the beginning and end of the school year. Parents filled out a self-report questionnaire about their reading abilities. Their answers were used to assign children to good or poor reader parent groups (GRP vs PRP). A logistic and ROC analysis were used to assess the variables' discriminative capability, considering literacy scores at the end of the year as a measure of reading achievement. GRP children obtained higher scores than PRP children did. Performance on tasks of rapid naming assessment (RAN) letters (78.6%), Word Reading (75.7%), and Deletion (75.6%) were the most accurate predictors of children's reading achievement. IPRA showed slightly lower accuracy (73.8) than did the behavioral measures and as high specificity as RAN letters (96.2%), similarly to the percentages found in previous studies. Although behavioral measures were shown as the best predictors, parents' self-reports could also provide a quick estimation of family risk of difficulties in literacy acquisition.

Pulsatile flow in ventricular catheters for hydrocephalus.

The obstruction of ventricular catheters (VCs) is a major problem in the standard treatment of hydrocephalus, the flow pattern of the cerebrospinal fluid (CSF) being one important factor thereof. As a first approach to this problem, some of the authors studied previously the CSF flow through VCs under time-independent boundary conditions by means of computational fluid dynamics in three-dimensional models. This allowed us to derive a few basic principles which led to designs with improved flow patterns regarding the obstruction problem. However, the flow of the CSF has actually a pulsatile nature because of the heart beating and blood flow. To address this fact, here we extend our previous computational study to models with oscillatory boundary conditions. The new results will be compared with the results for constant flows and discussed. It turns out that the corrections due to the pulsatility of the CSF are quantitatively small, which reinforces our previous findings and conclusions.This article is part of the themed issue 'Mathematical methods in medicine: neuroscience, cardiology and pathology'.

[An assessment of the management of spasticity in Spain: the 5E Study]. / Evaluacion del tratamiento de la espasticidad en España: estudio 5E.

INTRODUCTION: Although spasticity is a disabling complication of high incidence, there is a lack of either regional or national epidemiological studies in Spain evaluating its management. AIM: To evaluate the management of spasticity in Spain. PATIENTS AND METHODS: An epidemiological, observational, multicenter, and retrospective study involving 49 rehabilitation services of public and private hospitals was designed. RESULTS: Two hundred and thirty-five patients from 49 centers, with evidence of upper (UL) or lower limb (LL) spasticity with one valid baseline visit and at least one follow-up visit, were included. Among the patients included in the study 148 (62.9%) have post stroke spasticity; 79 (33.6%) have LL spasticity, 38 (16.1%) UL, and 118 (50.3%) in both. At baseline, Modified Ashworth Scale, goniometry, Visual Analog Scale for pain and Tardieu Scale had been performed in 164 (69.8%), 99 (42.1%), 85 (36.2%), and 26 (11.1%) patients, respectively. A 93.8% (IC 95%: 81.4-97.6%) of the centers accurately defined the treatment goals and 52% of the objectives were agreed with the patient. Botulinum A toxin was administered in 186 (79.1%) of patients; 49 (20.9%) patients were treated with oral antispastic medications and 93 (39.6%) were under physiotherapy treatment. CONCLUSIONS: Most of the patients have post-stroke spasticity. Moreover, botulinum A toxin was the most commonly treatment applied to patients with spasticity. The results demonstrate that the management of spasticity varies significantly across the different centers participating in the study.

TITLE: Evaluacion del tratamiento de la espasticidad en España: estudio 5E.Introduccion. Aunque la espasticidad es una secuela que presenta una incidencia alta, hay una carencia de estudios que evaluen su manejo terapeutico en España. Objetivo. Evaluar el tratamiento de la espasticidad en España. Pacientes y metodos. Estudio epidemiologico, observacional, multicentrico y retrospectivo en el que participaron 49 servicios de rehabilitacion de hospitales publicos y privados. Resultados. Se incluyeron 235 pacientes, con espasticidad del miembro superior (MS) o inferior (MI), que realizaron una visita basal valida y al menos una visita de seguimiento. De los pacientes incluidos en el estudio, 148 (62,9%) tenian espasticidad postictus; 79 (33,6%), espasticidad del MI; 38 (16,1%), del MS; y 118 (50,3%), de ambos. En la visita basal, la escala modificada de Ashworth, la goniometria, la escala analogica visual para el dolor y la escala de Tardieu se habian realizado en 164 (69,8%), 99 (42,1%), 85 (36,2%) y 26 (11,1%) pacientes, respectivamente. Un 93,8% (intervalo de confianza al 95%: 81,4-97,6%) de los centros definio los objetivos del tratamiento de forma exacta, y un 52% de los objetivos fueron consensuados con el paciente. La toxina botulinica tipo A se administro a 186 (79,1%) pacientes; 49 (20,9%) se trataron con antiespasticos orales, y 93 (39,6%), con fisioterapia. Conclusiones. La mayoria de los pacientes incluidos presentaban espasticidad postictus. Ademas, la toxina botulinica tipo A era el tratamiento mas comunmente aplicado a los pacientes con espasticidad. Los resultados demuestran que el tratamiento de la espasticidad varia considerablemente entre los diferentes centros participantes en el estudio.