[Tele-rehabilitation in musculoskeletal pathology of the upper and lower limb]. / Telerrehabilitación en patología musculoesquelética de miembro superior e inferior.

Chronic musculoskeletal conditions cause pain and disability and have significant impact on morbidity worldwide. Tele-rehabilitation is proposed as an alternative or complement to improve patient's muscle function, pain, and quality of life. However, the satisfaction of both patients and professionals must be assessed, together with the patient's daily life activity independence. A search of the literature was made to locate assessment reports, systematic reviews and reports from regulatory bodies with support from a documentarian from the Andalusian Health Technologies Assessment Area (AETSA). For this purpose, the following sources were used: Medline, EMBASE, INAHTA (international network of health technologies assessment) and PEDro (Physiotherapy Evidence Database) from 2014 onwards. Subsequently a secondary search was carried out on the articles selected in the initial search. A search of open clinical trials was also carried out in the database: www.ClinicalTrials.gov Initially 345 articles were identified. Duplicated articles (57) were excluded. By first analysing the title and abstract 238 articles were excluded. The full texts of the remaining 30 articles were analysed. Finally 18 articles were included.

Toward a sustainable circular economy for cigarette butts, the most common waste worldwide on the coast.

The circular economy is based on the maximum use of resources by reducing, reusing, and recycling the elements used. Currently, the items littered most frequently in the world are cigarettes butts (CB) as these debris are freely disseminated in the marine habitat, they are generally difficult to collect and very complex to recycle. Litter CB is a great social problem that generates excessive economic costs and serious environmental problems. CB is also not biodegradable and highly toxic to marine organisms and presents a distinctive mixture of physical and chemical contamination. However, little research has been done on the management and recycling of this dangerous waste. Several proposals have been made to incorporate this waste into high-volume articles of direct production or recycling, but collection logistics are lacking since the current system is inefficient, in addition to the poor environmental behaviour of citizens. This work presents a current synthesis of the CB problem from all its possible aspects in order to have a global vision of the life cycle of the CB, indicating both the known and the gaps in the knowledge of each of them, and intends to give a general outline of the steps to follow to try to end such a worrying problem at the global level.

Environmental consequences of dredged-material disposal in a recurrent marine dumping area near to Guadalquivir estuary, Spain.

In this study we assessed the effects of the recurrent disposal of dredged material from the Guadalquivir estuary (south-western Spain) in a marine disposal area. We analysed shifts in sediment characteristics as well as bioaccumulation and biomagnification of heavy metals through the benthic food web. Results showed that the significant increase in concentration of some heavy metals observed in the marine disposal area after the latest disposal event could be attributed to the deposition of river-dredged sediments. This increase could also explain the decreased amphipod survival in the ecotoxicology analysis. Heavy metal concentrations in organisms indicated some bioaccumulation in deposit feeders and predators but with no clear patterns nor biomagnification through the food web. Hence, combining studies that monitor shifts in sediment characteristics and their possible consequences for the food web seems to be an interesting approach that should be assessed further in this type of studies.

Environmental factors affecting the nursery function for fish in the main estuaries of the Gulf of Cadiz (south-west Iberian Peninsula).

Hydrological, geomorphological, physicochemical and biological factors influence the nursery function of estuaries. Our study compared the environmental conditions and the assemblages of early life stages of fish in the main four estuaries of the Gulf of Cadiz (Cadiz Bay, Guadalquivir, Odiel-Tinto and Guadiana). Samples were taken within each estuary and on their adjacent coast, during the dry-warm seasons of 2016, 2017 and 2018. Results showed that rivers with smaller basins had a very low freshwater input and their estuaries, Odiel-Tinto and Cadiz Bay, were essentially sea extensions into the land, containing similar physicochemical conditions to nearshore zones, as well as similar assemblages and densities of early life stages of fish. Open water masses of these estuaries do not have important nursery functions. In contrast, inner zones of estuaries with bigger basins and higher freshwater discharges, Guadalquivir and Guadiana, have different environmental characteristics and a long transition zone with a well-defined salinity gradient. Their assemblages and densities of early life stages of fish were different between them and with other estuaries. The Guadalquivir estuary held the highest abundance of larval and early juvenile fish, as well as macrozooplankton biomass. The most abundant fish species in all zones of every estuary was the anchovy Engraulis encrasicolus; the Guadalquivir inner zone had the highest density. High concentration of suspended organic matter, provided by freshwater input and correlated with total suspended solid, suspended inorganic matter and turbidity, was the physicochemical characteristic more typical of the Guadalquivir. This characteristic, in addition to the salinity gradient, could explain the highest densities of macrozooplankton found in this estuary, and consequently, of early fish stages. Recurrent jellyfish blooms were observed in Cadiz Bay and the inner zone of Guadiana, affecting their nursery functions. Odiel-Tinto showed altered physicochemical and biological characteristics, which may need further specific research.

CO2 leakage simulation: Effects of the decreasing pH to the survival and reproduction of two crustacean species.

The effects of CO2-related acidification on two crustacean populations, the isopod Cyathura carinata and the amphipod Elasmopus rapax, were studied. Three pH levels were tested: artificial seawater without CO2 injection and two levels of reduced pH. Even though RNA:DNA ratio was reduced for both species, no statistical significant differences were found between the control and the treatments. Both species experienced a reduction in survivorship, longevity and the body length of surviving animals; although the impairment observed in E. rapax was more severe than in C. carinata. The long life span isopod and the short life span amphipod experienced a high degree of impairment in the reproduction, likely due to the reallocation of resources from reproduction to body maintenance and increasing survival by postponing the brood production. Regardless of the underlying processes and the energetic pathways, both experienced failure to reproduce, which could lead to the local extinction of these species.

Human pressures on two estuaries of the Iberian Peninsula are reflected in food web structure.

As a result of the increased urban and agricultural development in coastal environments, estuaries are among the most modified and threatened aquatic ecosystems. This study used stable isotopes to examine the effects of human impacts by contrasting the food web structures of two Iberian estuaries exposed to different degrees of human pressure. More complex feeding pathways were found in the more altered estuary (Guadalquivir). Greater spread among species along the carbon axis suggests that the primary consumers exploit organic matter with various origins, whereas different nitrogen signals of the secondary consumers suggest that they feed on different suites of prey. In contrast, the similar isotopic signals of secondary consumers in the relatively little influenced estuary (Guadiana) suggests similarity in diet composition and feeding on the same organic matter sources. Understanding trophic interactions in estuaries is vital for defining proper management and conservation, and the preliminary data provided here are one step in this direction.

Intraspecific variation in the response of the estuarine European isopod Cyathura carinata (Krøyer, 1847) to ocean acidification.

In the present study the model isopod, Cyathura carinata were exposed to four pHNIST treatments (control: 7.9; 7.5, 7, 6.5) in order to determine the tolerance and pH threshold value this estuarine species withstand under future acidification scenarios. Seawater acidification significantly affected the lifespan of C. carinata, where population density was remarkably reduced at the lowest pH treatment. The longevity, survivorship and swimming activity (related to the acquisition of energy) of these isopods decreased with decreasing pH. Furthermore, to determine the possible metabolic plasticity of this species, the swimming activity, the Na+/K + -ATPase activity (relevant for osmoregulation process), and the RNA:DNA ratio (an indicator of fitness) were measure from two populations of C. carinata, one inhabiting a stable environment (pHNIST 7.5-8.0) and one inhabiting a fluctuating pCO2 regimes (pH 3.3-8.5) subjected to three pH treatments (7.9, 7.0 and 6.5). The population from high fluctuating pCO2 conditions showed capacity to withstand to pH 6.5, as well as higher longevity and metabolic plasticity, when compared with the population from the habitat with slight pCO2 variation. These results indicate that Cyathura population from stable environments could be vulnerable to ocean acidification because it could trigger detrimental effects on its survival energy budget, and growth. However, ocean acidification has limited effect on the energy budget and survival of C. carinata population from highly variable habitats, suggesting that they are able to cope with the elevated energy demand. The difference showed between populations is likely an indication of genetic differentiation in tolerance to ocean acidification, possibly attributable to local adaptations, which could provide the raw material necessary for adaptation to future conditions. In addition, our results suggest that when assessing marine crustacean responses to changing environments on a global scale, variability in population and metabolic responses need to be considered.

Maintenance dredging impacts on a highly stressed estuary (Guadalquivir estuary): A BACI approach through oligohaline and polyhaline habitats.

Understanding the effects of dredging in estuaries is a hard task due to the difficulty of implementing an adequate environmental diagnosis, as a consequence of the salinity gradient and anthropogenic disturbances. To assess the effects of maintenance dredging work on the Guadalquivir estuary (southwestern Spain), we used a Before-After-Control-Impact (BACI) approach to determine both direct and indirect effects in two salinity ranges. No effects were found on water and sediment physicochemical characteristics. The small impacts on dredged areas were followed by a rapid recovery of opportunistic species. The poor status of the benthos does not permit the detection of significant effects on macrofaunal community structure. The use of stable isotopes analysis to determine impacts on food web structure showed that changes over time seem to be explained by natural temporal variation rather than the dredging works. This paper emphasises the need to define proper management and conservation plans to improve the status of the benthic communities of the Guadalquivir estuary.

Impact of dredged-material disposal on soft-bottom communities in a recurrent marine dumping area near to Guadalquivir estuary, Spain.

This study assesses the effects of dredged material disposal in a recurrent marine dump near the Guadalquivir Estuary (south-western Spain). We compared the changes observed with two reference areas combining a classical ecological approach with new stable isotope techniques to analyse trophic structure. We detected permanent changes in the macrofaunal community structure as well as in the diversity and biotic indices applied, which showed higher values in the disposal area. The community in the marine dump had lost the natural temporal variations observed in the reference areas. These effects could be due to the last disposal event carried out in the summer of 2015 or to the recurrent disposals since 2010. Despite the structural changes shown by the benthic community, these impacts were not reflected in the food web structure of the marine dump. Our results confirm the high variability of disposal disturbances. Hence, we recommend performing studies in every disposal event, merging different functional and structural approaches.

BENFES, a new biotic index for assessing ecological status of soft-bottom communities. Towards a lower taxonomic complexity, greater reliability and less effort.

The new biotic index BENFES (Benthic Families Ecological Status Index) for assessing the ecological status of soft-bottom communities based on presence/absence at the taxonomic family level, is described. BENFES was primarily developed for the communities from the Guadalquivir estuary (South-western Spain), but the aim of the present work was to evaluate the reliability and validity of this index for its application in the Water Framework Directive (WFD), especially as a preliminary and rapid assessment method for monitoring the ecological status of transitional and coastal waters. BENFES was compared with five widely used indices (BOPA, BO2A, BENTIX; AMBI and M-AMBI) in several studies from Southwestern Spain. In addition, we have also established comparisons between these indices and the most commonly used Shannon-Wiener diversity. M-AMBI and BENFES showed the best agreement in ecological status assignation and were the most useful and discriminant between the studied areas. BENTIX was a good discriminant in coastal areas but was severe with the environmental condition from estuaries; BOPA/BO2A did not show clear trends in most of the zones; and AMBI tended to provide overestimations of the ecological status. In conclusion, BENFES shows several advantages such as lower taxonomic resolution, greater reliability and only requiring presence/absence. All this implies a huge possibility to perform a simplified monitoring routine for the control of the ecological quality of water bodies.

Retrospective study of various conservative treatment options with bacille Calmette-Guérin in bladder urothelial carcinoma T1G3: Maintenance therapy. / Estudio retrospectivo de diferentes opciones de tratamiento conservador con Bacilo de Calmette-Guèrin en el carcinoma urotelial vesical T1G3: terapia de mantenimiento.

OBJECTIVE: To compare various conservative treatment options for high-grade T1 nonmuscle-invasive bladder cancer (NMIBC). Bacille Calmette-Guérin (BCG) is the preferred intravesical treatment for high-grade T1 tumours; however, a number of experts still question the need for maintenance BCG. MATERIAL AND METHODS: We retrospectively analysed data from 1039 patients with primary and recurrent T1G3 NMIBC. All patients underwent complete transurethral resection of the bladder tumour (TURBT), with muscle in the sample and multiple bladder biopsies. The patients were treated with the following: only one initial TURBT (n=108), re-TURBT (n=153), induction with 27mg of BCG (Connaught strain) (n=87), induction with 81mg of BCG (n=489) or induction with 81mg of BCG+maintenance (n=202). The time to first recurrence, progression (to T2 or greater or to metastatic disease) and specific mortality of the disease was assessed using the Kaplan-Meier survival function and were compared using the log-rank test and the Cox multivariate regression model of proportional risks. RESULTS: The mean follow-up was 62±39 months. The risk of recurrence was significantly lower for the patients treated with maintenance therapy of 81mg of BCG than in the other treatment groups (P<.001). The risk of tumour progression was also significantly lower for the patients treated with maintenance BCG than for the patients treated only with one TURBT, re-TURBT and with induction therapy with 27mg of BCG (P=.0003). The specific disease mortality was significantly lower with BCG maintenance (9.4%) than with only one TURBT (27.8%; P=.003). CONCLUSIONS: In the case of T1G3 NMIBC, a complete dose of BCG with maintenance is associated with better recurrence results than are other conservative treatment modalities. The results of progression and survival specific to the disease were also better with induction BCG, with or without maintenance.

[Neonatal stage IV and IVs neuroblastoma: surgical treatment with silo and liver reduction]. / Neuroblastoma neonatal estadio IV y IVs: Tratamiento quirúrgico con silo y reducción hepática.

UNLABELLED: Hepatic metastases of neonatal neuroblastoma can cause multiple organ failure due to rapid growth and severe hepatomegaly. The objective of this work is to present two infants with neuroblastoma stage IV and IVs in a critical situation that needed a decompressive abdominal silo and surgical liver reduction for definitive abdominal closure. Currently both children are 6 years old and they are free from disease. CONCLUSION: The placement of a silo for abdominal decompression is still an indication for salvage. Surgical hepatic reduction is an alternative for the early closure of the abdomen avoiding complications due to infection or dehiscence of the silo.

Nonurgent aortic disease: clinical-radiological diagnosis of aortitis.

Aortitis is a pathological term designating inflammation of the aortic wall, regardless of its cause. The clinical presentation of aortitis is nonspecific and variable. Symptoms include abdominal pain, fever, and weight loss; acute phase reactants may also be elevated. Aortitis can be caused by a wide spectrum of entities, including from infectious processes to autoimmune diseases (Takayasu arteritis and giant cell arteritis are among the most common of these causing aortitis), and the prognosis and treatment of these entities vary widely. Various imaging techniques can be used to evaluate the lumen and wall of the aorta (such as multidetector computed tomography, magnetic resonance imaging, angiography, or PET-CT). This review focuses on the most common diseases that cause aortitis and on the clinical and radiological findings that are most useful for diagnosing and treating this condition appropriately.

Molecular and functional characterization of a Schistosoma bovis annexin: fibrinolytic and anticoagulant activity.

Annexins belong to an evolutionarily conserved multigene family of proteins expressed throughout the animal and plant kingdoms. Although they are soluble cytosolic proteins that lack signal sequences, they have also been detected in extracellular fluids and have been associated with cell surface membranes, where they could be involved in anti-haemostatic and anti-inflammatory functions. Schistosome annexins have been identified on the parasite's tegument surface and excretory/secretory products, but their functions are still unknown. Here we report the cloning, sequencing, in silico analysis, and functional characterization of a Schistosoma bovis annexin. The predicted protein has typical annexin secondary and tertiary structures. Bioassays with the recombinant protein revealed that the protein is biologically active in vitro, showing fibrinolytic and anticoagulant properties. Finally, the expression of the native protein on the tegument surface of S. bovis schistosomula and adult worms is demonstrated, revealing the possibility of exposure to the host's immune system and thus offering a potential vaccine target for the control of schistosomiasis in ruminants.

Electronic device for endosurgical skills training (EDEST): study of reliability.

PURPOSE: Minimally Invasive Surgery procedures are commonly used in many surgical practices, but surgeons need specific training models and devices due to its difficulty and complexity. In this paper, an innovative electronic device for endosurgical skills training (EDEST) is presented. A study on reliability for this device was performed. METHOD: Different electronic components were used to compose this new training device. The EDEST was focused on two basic laparoscopic tasks: triangulation and coordination manoeuvres. A configuration and statistical software was developed to complement the functionality of the device. A calibration method was used to assure the proper work of the device. A total of 35 subjects (8 experts and 27 novices) were used to check the reliability of the system using the MTBF analysis. RESULTS: Configuration values for triangulation and coordination exercises were calculated as 0.5 s limit threshold and 800-11,000 lux range of light intensity, respectively. Zero errors in 1,050 executions (0%) for triangulation and 21 errors in 5,670 executions (0.37%) for coordination were obtained. A MTBF of 2.97 h was obtained. CONCLUSIONS: The results show that the reliability of the EDEST device is acceptable when used under previously defined light conditions. These results along with previous work could demonstrate that the EDEST device can help surgeons during first training stages.

Crustacean assemblages in a polluted estuary from South-Western Spain.

The spatial-temporal variation in crustacean assemblages of the Odiel-Tinto estuary, one of the most polluted areas in the world, was studied in 2000, 2002 and 2004. The crustacean assemblages were mainly established according to the natural gradient from estuarine to marine environment (based on water and sediment characteristics such as dissolved oxygen, salinity, granulometry or organic content). Pollutants such as copper, zinc or phosphates could also explain partially this pattern based on BIOENV and canonical correspondence analyses. However, there were clear symptoms of perturbation, mainly in the inner areas, such as a low number of species and a low abundance, especially in relation to the typical estuarine species (e.g. Cyathura carinata, Corophium spp.). This study provides baseline information which can be used as a reference point in a long-term perspective.

[Nasal neurinoma: communication of a case and clinicopathologic analysis]. / Neurinoma de fosa nasal: comunicación de un caso y análisis clinicopatológico.

The schwannomas are tumors arising from nervous tissue. It appears very rarely in the nose and paranasal sinuses. We report a case of a female whit nasal obstruction that presents a nasal neurinoma schwannoma.

[Supracricoid partial laryngectomy: quality of life assessment]. / Laringectomía parcial supracricoidea. Análisis de calidad de vida.

OBJECTIVES: To assess quality of life in patients diagnosed with epidermoid carcinoma of the larynx, after supracricoid partial laryngectomy (SCPL). To examine how quality-of-life may be associated to the treatment received. PATIENTS AND METHOD: A descriptive, observational, cross-sectional study was conducted involving 32 patients out of a group of 57. They were all males with an average age of 63.3 years at the time of the interview. We used the disease-specific quality of life questionnaire devised by the University of Michigan: the Head and Neck Cancer-specific Quality of life instrument (HNQOL). RESULTS: During an average follow-up period of 86 months, 3 patients (5.26%) suffered a recurrence. Estimated survival after 3, 5 and 10 years was 94.73%. Communication and overall bother caused by treatment were found to be the two quality-of-life domains mainly affected. Patients who had received CHP, radiotherapy, those who had not had their tracheal cannula removed or had undergone neck dissection were the most affected. CONCLUSIONS: SCPL as a surgical technique allows good control of the condition and has a low impact on the patient's quality of life.

[Middle ear adenoma: our casuistry and revision of the literature]. / Adenoma de oído medio: nuestra casuística y revisión de la literatura.

Tumours of the middle ear are rare. Among them glomus tympanicum is the most frequent, followed by adenoma of the middle ear (AME). This insidious pathology entity displays unspecific clinical and audiological features. Advances in histology and immunohistochemistry have greatly contributed to an accurate diagnosis. We report our experience with two patients, a middle-aged man and a woman, diagnosed in our hospital. Both patients underwent surgical treatment and have shown no signs of recurrence after a 27- and 28-month follow-up. In both cases an accurate diagnosis was confirmed by histological and immunohistochemical analysis.