Study of tyrosine and dopa enantiomers as tyrosinase substrates initiating l- and d-melanogenesis pathways.

Tyrosinase starts melanogenesis and determines its course, catalyzing the oxidation by molecular oxygen of tyrosine to dopa, and that of dopa to dopaquinone. Then, nonenzymatic coupling reactions lead to dopachrome, which evolves toward melanin. Recently, it has been reported that d-tyrosine acts as tyrosinase inhibitor and depigmenting agent. The action of tyrosinase on the enantiomers of tyrosine (l-tyrosine and d-tyrosine) and dopa (l-dopa and d-dopa) was studied for the first time focusing on quantitative transient phase kinetics. Post-steady-state transient phase studies revealed that l-dopachrome is formed more rapidly than d-dopachrome. This is due to the lower values of Michaelis constants for l-enantiomers than for d-enantiomers, although the maximum rates are equal for both enantiomers. A deeper analysis of the inter-steady-state transient phase of monophenols demonstrated that the enantiomer d-tyrosine causes a longer lag period and a lower steady-state rate, than l-tyrosine at the same concentration. Therefore, d-melanogenesis from d-tyrosine occurs more slowly than does l-melanogenesis from l-tyrosine, which suggests the apparent inhibition of melanin biosynthesis by d-tyrosine. As conclusion, d-tyrosine acts as a real substrate of tyrosinase, with low catalytic efficiency and, therefore, delays the formation of d-melanin.

Patient opinion of analgesia during external cephalic version at term in singleton pregnancy.

To assess the opinion and the level of satisfaction of patients concerning analgesia during external cephalic version (ECV), we present the results of a survey of 120 women undergoing ECV at term during a randomised controlled trial (July 2012 to February 2013) comparing remifentanil and nitrous oxide. Overall, 110 (91.7%) women said they would repeat the procedure and 111 (92.5%) that they would recommend it to another pregnant woman, with no significant differences by type of analgesia. The administration and sense of comfort were rated better in the remifentanil group (p < .01). In conclusion, the use of analgesia during ECV is associated with a high rate of willingness among women to repeat the procedure and recommend it to other pregnant women.Impact statementWhat is already known on this subject? ECV is commonly a painful manoeuvre for the woman. This pain triggers maternal reactive abdominal muscle contraction and involuntary abdominal tensing, reducing the likelihood of successful version and causing some women to reject the technique.What do the results of this study add? The use of analgesia during ECV is associated with a high rate of willingness among women to repeat the procedure and recommend it to other pregnant women. The sense of comfort during ECV was also significantly better in the remifentanil group, probably because of its greater analgesic power and greater comfort during its administration.What are the implications of these findings for clinical practice and/or further research? ECV should be carried out under analgesia, when available, not only to decrease pain but also to encourage wider adoption of the technique and enable more women to benefit from it.

Parents and Physiotherapists Recognition of Non-Verbal Communication of Pain in Individuals with Cerebral Palsy.

Pain assessment is difficult in individuals with cerebral palsy (CP). This is of particular relevance in children with communication difficulties, when non-verbal pain behaviors could be essential for appropriate pain recognition. Parents are considered good proxies in the recognition of pain in their children; however, health professionals also need a good understanding of their patients' pain experience. This study aims at analyzing the agreement between parents' and physiotherapists' assessments of verbal and non-verbal pain behaviors in individuals with CP. A written survey about pain characteristics and non-verbal pain expression of 96 persons with CP (45 classified as communicative, and 51 as non-communicative individuals) was performed. Parents and physiotherapists displayed a high agreement in their estimations of the presence of chronic pain, healthcare seeking, pain intensity and pain interference, as well as in non-verbal pain behaviors. Physiotherapists and parents can recognize pain behaviors in individuals with CP regardless of communication disabilities.

Increased pain relief with remifentanil does not improve the success rate of external cephalic version: a randomized controlled trial.

INTRODUCTION: Our objective was to compare the effect of two pain relief methods (remifentanil vs. nitrous oxide) on the success rate of external cephalic version. MATERIAL AND METHODS: We conducted a randomized open label parallel-group controlled single-center clinical trial with sequential design, at Cruces University Hospital, Spain. Singleton pregnancies in noncephalic presentation at term that were referred for external cephalic version were assigned according to a balanced (1:1) restricted randomization scheme to analgesic treatment with remifentanil or nitrous oxide during the procedure. The primary endpoint was external cephalic version success rate. Secondary endpoints were adverse event rate, degree of pain, cesarean rate and perinatal outcomes. RESULTS: The trial was stopped early after the second interim analysis due to a very low likelihood of finding substantial differences in efficacy (futility). The external cephalic version success rate was the same in the two arms (31/60, 51.7%) with 120 women recruited, 60 in each arm. The mean pain score was significantly lower in the remifentanil group (3.2 ± 2.4 vs. 6.0 ± 2.3; p < 0.01). No differences were found in external cephalic version-related complications. There was a trend toward a higher frequency of adverse effects in the remifentanil group (18.3% vs. 6.7%, p = 0.10), with a significantly higher incidence rate (21.7 events/100 women vs. 6.7 events/100 women with nitrous oxide, p = 0.03). All reported adverse events were mild and reversible. CONCLUSIONS: Remifentanil for analgesia decreased external cephalic version-related pain but did not increase the success rate of external cephalic version at term and appeared to be associated with an increased frequency of mild adverse effects.

Screening of biomethane production potential from dominant microalgae.

The use of microalgae for biomethane production has been considerably increasing during the recent years. In this study, four dominant species belonging to the genera Scenedesmus, Chlorella, Dunaliella and Nostoc were selected. The influence of different genera with several morphological, structural and physicochemical characteristics on methane production was assessed in biochemical methane potential (BMP) tests. The ultimate methane yield values were 332 ± 24, 211 ± 2, 63 ± 17 and 28 ± 10 mL CH4/g VSadded for Scenedesmus obliquus, Chlorella sorokiniana, Dunaliella salina and Nostoc sp., respectively. The highest methane production was achieved by microalga species that had no complex cell wall or wall basically composed by proteins and simple sugars such as in S. obliquus, whereas lower methane yields were found for D. salina and Nostoc sp., due to the salinity effects and cell wall composition in terms of complex polysaccharide and glycolipid layers, respectively. Kinetic constant values obtained in the BMP tests ranged between 1.00 ± 0.08 and 0.097 ± 0.005 days(-1) for D. salina and S. obliquus, respectively.

Development of emotional intelligence and assertiveness in physiotherapy students and effects of clinical placements.

BACKGROUND: Emotional intelligence (EI) and assertiveness are key abilities for physiotherapists. Clinical placements seem to affect students' development of EI and assertiveness, and their construction of the professional role. PURPOSE: This study aims to compare the EI of physiotherapy students with students from other health professions and explore the evolution of EI and assertiveness in physiotherapy students throughout their university education, focusing on the influence of clinical practice. METHOD: Students (N = 753) completed a self-administered questionnaire to measure emotional intelligence (TMMS 24), assertiveness (CSES), and sociodemographic variables. RESULTS: EI levels were adequate and very similar across the three disciplines. Regarding assertiveness, physiotherapy students in year 4 obtained significantly higher levels than students in years 1, 2, and 3. Significant correlations (rs (207) = 0.35, p < .001) were found between assertiveness and the number of modules of clinical practice. CONCLUSION: This study contributes with further evidence on the improvement of assertiveness in physiotherapy students through their university education and, in particular, with clinical placements. Practical implications highlight the importance of training in EI and assertiveness during university, coupled with clinical placements, in order to prepare for an effective and satisfactory professional life.

Injuries, Pain, and Catastrophizing Level in Gymnasts: A Retrospective Analysis of a Cohort of Spanish Athletes.

Physical and psychological demands from gymnastics increase the occurrence of injuries and pain among athletes, whose consequent level of catastrophizing could affect rehabilitation and performance. Although the characteristics of each gymnastics discipline may be key factors, they remain unclear. This study aimed to describe injuries, pain, and catastrophizing levels of gymnasts, according to their discipline and training characteristics. A total of 160 gymnasts fulfilled an online survey at the end of the 2021 season. Eighty gymnasts sustained 106 injuries (mainly ankle), and 128 had current pain (mainly low back). Although results were similar among disciplines, rhythmic gymnasts had a higher prevalence of low back pain (p = 0.003) and artistic wrist pain (p = 0.011). Gymnasts who sustained an injury displayed higher hours of training (p = 0.026), and those with current pain had more sports experience (p = 0.001) and age (p < 0.001). A higher catastrophizing level was observed in injured gymnasts and correlated with pain level (p < 0.001). No other differences were found (p > 0.05). Pain and injury prevalence is extremely high among gymnasts, being specific to the gymnastics discipline and increasing catastrophizing experience. Hours of training, age, and sports experience are key related factors, regardless of discipline.

[A vacuum assisted closure system in complex wounds: a retrospective study]. / Sistema de cierre asistido por vacío en heridas complejas. Estudio retrospectivo.

INTRODUCTION: Vacuum-assisted closure (VAC) therapy is a dynamic and non-invasive system for improving wound healing. This novel therapy is based on applying air suction at a controlled sub-atmospheric pressure. The most important benefits of this therapy include, a reduction in the wound area together with induction of new granulation tissue formation, effective wound cleansing (removal of small tissue by suction), and the continuous removal of wound exudate. The aim of this study was to describe our experience with VAC therapy for complex wounds. MATERIAL AND METHOD: We retrospectively evaluated our experience with VAC therapy between April 2007 and August 2008. We employed a "suprafascial" VAC system and an open abdomen VAC system. Descriptive statistical techniques were applied and percentages and means were calculated. RESULTS: VAC therapy was applied in 20 patients, of whom 16(80%) had abdominal complex wounds, and 4(20%) in other locations. We employed a "suprafascial" VAC system in 17 patients (85%) and an "intra-abdominal" VAC system in 3 patients (15%). Two patients (10%) developed fistula during "intra-abdominal" VAC therapy (urinary and enteric) but the closure was achieved before therapy was finished. Mean hospital stay was 38.3 days (7-136). No mortality was directly due to the VAC system. Two patients (10%) died due to their septic condition and the rest are still alive. Mean therapy length was 29.17 days (1-77) in the "suprafascial" group and 18 days (7-49) in the "intra-abdominal" group. Average costs were 3197.97 euro (119.1-10780.25) per patient. CONCLUSIONS: VAC therapy can improve and accelerate abdominal wound healing also in the presence of infection and bowel fistula.

Face-to-Face and blended methods to improve oral competence in nursing students through simulation.

Communication and interpersonal skills are relevant to the health professions, so it is important to promote these competencies at university. This research assesses the effectiveness of teaching oral competence through simulation using face-to-face and blended methods. A public speaking workshop was conducted in a group of 144 first year nursing students. Three groups were obtained according to the teaching method (Group 1: traditional method-3 sessions, Group 2: traditional method-2 sessions, Group 3: blended method-2 sessions). Public speaking confidence was measured at the beginning and end of the training, and oral competence was assessed at the end. As a result, all groups achieved a good level of oral competence after the training. However, while students in Group 1 showed greater oral competence, with regard to confidence in public speaking, students in Group 1 showed significantly worst results than those in Group 3. We concluded that simulation is a useful strategy to improve cognitive learning, and behavioural and practical competencies such as public speaking. As for the teaching method, although blended learning did not offer better results than traditional learning, it seems useful provide there is at least one face-to-face session so that the student can perform a speech and receive corrective feedback.

La escritura creativa en estudiantes universitarios del ámbito socio sanitario: Revisión sistemática / Escrita criativa em universitários da área socio saúde: revisão sistemática / Creative writing in university students from the socio-sanitary field: Systematic Review

El uso de la escritura creativa basada en la Medicina Narrativa (MN) como aprendizajeactivo para la enseñanza del rol profesional en Ciencias de la Salud, ha despertado interés en losúltimos años. Se realizó una revisión sistemática exploratoria para conocer la eficacia de su aplica-ción en estudiantes universitarios del ámbito de las ciencias sociales y de la salud. Los estudiosfueron recuperados de WoS, Scopus, Dialnet y REDIB. El análisis de 8 artículos seleccionados des-cribió esta metodología como herramienta útil para fomentar las voces narrativas de los estudiantes,impulsar la reflexión sobre encuentros clínicos, fomentar la atención clínica atenta y empática yfacilitar la gestión emocional. Esta metodología permite además el desarrollo de destrezas del len-guaje, creatividad y espontaneidad en la construcción de la identidad profesional y sobre el profe-sionalismo. A pesar de la escasez de estudios, parece prometedora su utilidad a nivel curricular,aunque se precisa analizar con profundidad el fenómeno de estudio.(AU)

The use of creative writing based on Narrative Medicine (NM) as active learning for theteaching of the professional role in Health Sciences, has aroused interest in recent years. Anexploratory systematic review was carried out to know the effectiveness of its application inuniversity students in the field of social sciences and health. The studies were retrieved from WoS,Scopus, Dialnet and REDIB. The analysis of 8 selected articles described this methodology as auseful tool to foster the narrative voices of students, encourage reflection on clinical encounters,encourage attentive and empathetic clinical care and facilitate emotional management. Thismethodology also allows the development of language skills, creativity, and spontaneity in theconstruction of professional identity and professionalism. Despite the scarcity of studies, itsusefulness at the curricular level seems promising, although it is necessary to analyze in depth thephenomenon of study.(AU)

A utilização da escrita criativa baseada na Medicina Narrativa (MN) como aprendizagemativa para o ensino do papel profissional em Ciências da Saúde tem despertado interesse nos últi-mos anos. Uma revisão sistemática exploratória foi realizada para determinar a eficácia de sua apli-cação em estudantes universitários no campo das ciências sociais e da saúde. Os estudos foram re-cuperados de WoS, Scopus, Dialnet e REDIB. A análise de 8 artigos selecionados descreveu essametodologia como uma ferramenta útil para estimular as vozes narrativas dos alunos, estimular areflexão sobre os encontros clínicos, promover um atendimento clínico atencioso e empático e faci-litar o gerenciamento emocional. Esta metodologia permite também o desenvolvimento de compe-tências linguísticas, criatividade e espontaneidade na construção da identidade profissional e doprofissionalismo. Apesar da escassez de estudos, sua utilidade em nível curricular parece promis-sora, embora o fenômeno do estudo precise ser analisado em profundidade.(AU)

Uncontrolled donation programs after out-of-hospital cardiac arrest. An estimation of potential donors.

OBJECTIVE: To determine the number of potential deceased organ donors from out-of- hospital cardiac arrest cases (OHCA) attended by public physician-led emergency medical services in Spain, based on data recorded in the nationwide Spanish OHCA Registry (OHSCAR). MATERIAL AND METHODS: We analysed OHSCAR data on deceased OHCA patients in Spain during 13 months (1/10/2013 to 31/10/2014). Variables included age, sex, estimated OHCA time, cardiopulmonary resuscitation (CPR) start time and outcome. Inclusion criteria were: age 16-60 years, witnessed OHCA, no return of spontaneous circulation (ROSC) and time interval <15min between OHCA occurrence and CPR initiation. RESULTS: Of a total 8789 cases, 3290 met the age criteria; of these, CPR was not witnessed in 745 cases. Among the remaining 2545 patients, 141 were included in uncontrolled donation after cardiac death (uDCD) programs, 902 arrived at the hospital with ROSC, 64 arrived with ongoing CPR and 15 cases were lost to follow-up. Of the remaining 1423 without ROSC, CPR initiation time was not recorded in 454 cases and 398 did not meet the time criteria <15min between OHCA and CPR initiation. Finally, 571 met all the criteria and could have been potential donors. There were significant differences in the actual donors percentage from potential donors percentage between provinces with and without donor programs (141/322=43.8% versus 0/390=0%), but there were no differences in ROSC between the two types of provinces (418/1320=31.7% versus 652/1970=33.4%). CONCLUSIONS: Many potential donors are missed in current clinical practice. uDCD programs are few and underused even in a country with high rates of organ transplantation.

Role of alpha-actin in muscle damage of injured athletes in comparison with traditional markers.

OBJECTIVE: In order to identify a reliable marker for the early detection of muscle injuries in sports, alpha-actin protein and other markers of muscle damage were studied in sera of uninjured sportspeople and those with skeletal muscle injury. METHODS: Blood samples were obtained from 20 sportspeople with skeletal muscle injury and 48 uninjured sportspeople. Immunoassays were performed to determine cardiac troponin I (TnI), troponin T, lactate dehydrogenase and myoglobin concentrations. Western blot and densitometry were used to measure alpha-actin concentrations. Skeletal muscle damage was diagnosed according to physical examination, MRI findings and the biochemical criterion of a creatine kinase value >500 IU/l (Rosalki method, Beckman Instruments SL, Fullerton, California, USA). Results were also compared with previously obtained data on injured and uninjured non-sportspeople. RESULTS: The mean serum concentration of alpha-actin was significantly higher in sportspeople with muscle damage (10.49 microg/ml) than in uninjured sportspeople (3.99 mcirog/ml). Sera from injured sportspeople showed higher levels of alpha-actin than of troponin or myoglobin. No significant difference in TnI levels was observed between the groups. CONCLUSIONS: According to these results, alpha-actin is a new and reliable marker of skeletal muscle damage in sportspeople which can be used for the detection of muscle injury. Possible cross interference between skeletal and cardiac muscle damage can be discriminated by the combined use of alpha-actin and TnI. These data suggest that early measurement of alpha-actin in sportspeople with suspected muscle damage will allow them to receive earlier and more effective treatment and to return sooner to the practice of their sport.

A Step toward High-Energy Silicon-Based Thin Film Lithium Ion Batteries.

The next generation of lithium ion batteries (LIBs) with increased energy density for large-scale applications, such as electric mobility, and also for small electronic devices, such as microbatteries and on-chip batteries, requires advanced electrode active materials with enhanced specific and volumetric capacities. In this regard, silicon as anode material has attracted much attention due to its high specific capacity. However, the enormous volume changes during lithiation/delithiation are still a main obstacle avoiding the broad commercial use of Si-based electrodes. In this work, Si-based thin film electrodes, prepared by magnetron sputtering, are studied. Herein, we present a sophisticated surface design and electrode structure modification by amorphous carbon layers to increase the mechanical integrity and, thus, the electrochemical performance. Therefore, the influence of amorphous C thin film layers, either deposited on top (C/Si) or incorporated between the amorphous Si thin film layers (Si/C/Si), was characterized according to their physical and electrochemical properties. The thin film electrodes were thoroughly studied by means of electrochemical impedance spectroscopy, Raman spectroscopy, X-ray photoelectron spectroscopy, and atomic force microscopy. We can show that the silicon thin film electrodes with an amorphous C layer showed a remarkably improved electrochemical performance in terms of capacity retention and Coulombic efficiency. The C layer is able to mitigate the mechanical stress during lithiation of the Si thin film by buffering the volume changes and to reduce the loss of active lithium during solid electrolyte interphase formation and cycling.

Impact of Three-Dimensional Laparoscopy in a Bariatric Surgery Program: Influence in the Learning Curve.

INTRODUCTION: 3D laparoscopy allows the surgeon to regain the sense of depth and improve accuracy. The aim of the study was to assess the impact of 3D in bariatric surgery. PATIENTS AND METHODS: A retrospective cohort study was conducted. All our patients who underwent bariatric surgery (sleeve gastrectomy (SG) or gastric bypass (GB)) between 2013 and 2016 were included. We compared 3D laparoscopy cohort and 2D laparoscopy cohort. Variables are as follows: age, sex, DM, hypertension, surgeon experience, and type of intervention. Comparisons of operative time, hospital stay, conversion, complications, reoperation, and exitus are completed. RESULTS: Three hundred twelve consecutive patients were included. 56.9% of patients underwent GB and 43.1% SG. Global complications were 3.2% (fistula 2.5%, hemoperitoneum 0.3%, others 0.4%). One hundred four procedures were performed in the 3D cohort and 208 in the 2D cohort. The 2D cohort and 3D cohort were similar regarding the following: percentage of GB vs SG, age, gender, learning curve, diabetes mellitus 2, hypertension, and sleep apnea. The operating time and hospital stay were significantly reduced in the 3D cohort (144.07 ± 58.07 vs 172.11 ± 76.11 min and 5.12 ± 9.6 vs 7.7 ± 13.2 days. It was the same when we stratified the sample by type of surgery or experience of the surgeon. Complications were reduced in the 3D cohort in the surgeries performed by novice surgeons (10.2 vs 1.8%, p = 0.034). CONCLUSIONS: The use of 3D laparoscopy in bariatric surgery in our center has helped reducing the operating time and hospital stay, and improving the safety of the surgery, either in GB or SG, being equally favorable in novice or more experienced surgeons.

[Student stress in clinical practice for nurses]. / El estrés de los estudiantes en las prácticas clínicas de enfermería.

Stress is an adaptive phenomenon of human beings which, to a high degree, contributes to their survival, to an adequate output in their activities, and to an effective performance in many phases of life. But all of us know and have experienced the disagreeable aspects of stress at least once. During their academic lives, nursing students who fulfill their clinical practice are exposed to suffer symptoms specific to nursing in the field of stress.

La comunicación como esencia en el arte de cuidar / A comunicação como a essência da arte de cuidar / Communication as the essence of the art of caring

El acto comunicativo es complejo, simbólico y difícil. Más aún si se establece entreprofesional de la salud y paciente y familia. Un entorno en ocasiones hostil como es el propioproceso de enfermedad. Se producen circunstancias y situaciones que hacen que el profesionaltenga que atender no solamente a sus propias habilidades y destrezas sino también a los posibleselementos distorsionantes del proceso comunicativo. Con este texto se pretende reflexionar sobrela comunicación en este encuentro e identificar elementos facilitadores y distorsionantes.(AU)

The communicative act is complex, symbolic and difficult. Even more so if it isestablished between the health professional and the patient and family. An environment that issometimes hostile, such as the disease process itself. Circumstances and situations occur thatmake the professional have to attend only to their own abilities and skills but also to the possibledistorting elements of the communication process. This text is intended to reflect oncommunication in this meeting and identify facilitating and distorting elements.(AU)

O acto comunicativo é complexo, simbólico e difícil. Ainda mais se for estabelecido entreo profissional de saúde e o paciente e a família. Um ambiente por vezes hostil, tal como o próprioprocesso da doença. Surgem circunstâncias e situações que obrigam o profissional a prestaratenção não só às suas próprias competências e capacidades, mas também aos possíveis elementosde distorção do processo comunicativo. O objectivo deste texto é reflectir sobre a comunicaçãoneste encontro e identificar elementos facilitadores e distorcedores.(AU)

Emotional variables, dropout and academic performance in Spanish nursing students.

The dropout of university studies is a main concern in many countries, also for Health Sciences degrees. The reviews on dropout in all university degrees as well as nursing generally show multidimensional causes with factors related both to institutional and students' characteristics. Regarding the personal variables of students, researchers have focused on financial, family and personality features. Far less attention has been devoted to emotional variables. This study aims to explore whether individual variables of the emotional domain such as perceived emotional intelligence, dispositional optimism/pessimism and depressive rumination are related and/or can predict students' intention to dropout and academic performance. Using a cross-correlational approach, data were obtained from a sample of 144 nursing students. Students with a pessimistic disposition revealed a greater tendency to drop out. The remaining variables correlated significantly with pessimism but had no predictive value on dropout. Our results suggest that students with low levels of emotional clarity and repair and high depressive rumination have pessimistic expectations, so they are more likely to leave studies. No significant results were found in relation to academic performance. We conclude with an identification of strategies to increase retention and academic success.

Investigation of Bolivian plant extracts for their radical scavenging activity and antioxidant activity.

Fifty-four different extracts of nine Bolivian plants belonging to the family Asteraceae were evaluated for their radical scavenging activity by the DPPH*, NBT/hypoxanthine superoxide, and (*)OH/luminol chemiluminescence methods, and for their antioxidant activity by the beta-carotene bleaching test. The total phenolic content was also determined by the Folin-Ciocalteu method, and the oxidative stability by the Rancimat test. Both remarkably high phenolic content and radical scavenging and antioxidant activities were found mainly in the ethyl acetate fractions among the different plant extracts. Some ethyl acetate and even some defatted crude extracts exhibited activities comparable to those of commercial extracts/compounds, thus making it possible to consider some of the studied plants as a potential source of antioxidants of natural origin.