Changing climate both increases and decreases European river floods.

Climate change has led to concerns about increasing river floods resulting from the greater water-holding capacity of a warmer atmosphere1. These concerns are reinforced by evidence of increasing economic losses associated with flooding in many parts of the world, including Europe2. Any changes in river floods would have lasting implications for the design of flood protection measures and flood risk zoning. However, existing studies have been unable to identify a consistent continental-scale climatic-change signal in flood discharge observations in Europe3, because of the limited spatial coverage and number of hydrometric stations. Here we demonstrate clear regional patterns of both increases and decreases in observed river flood discharges in the past five decades in Europe, which are manifestations of a changing climate. Our results-arising from the most complete database of European flooding so far-suggest that: increasing autumn and winter rainfall has resulted in increasing floods in northwestern Europe; decreasing precipitation and increasing evaporation have led to decreasing floods in medium and large catchments in southern Europe; and decreasing snow cover and snowmelt, resulting from warmer temperatures, have led to decreasing floods in eastern Europe. Regional flood discharge trends in Europe range from an increase of about 11 per cent per decade to a decrease of 23 per cent. Notwithstanding the spatial and temporal heterogeneity of the observational record, the flood changes identified here are broadly consistent with climate model projections for the next century4,5, suggesting that climate-driven changes are already happening and supporting calls for the consideration of climate change in flood risk management.

Haemoglobinopathies and other rare anemias in Spain: ten years of a nationwide registry (REHem-AR).

REHem-AR was created in 2013. The progressive implementation of neonatal screening for haemoglobinopathies in Spanish autonomous communities where the registry had not been implemented, as well as the addition of new centres during this period, has considerably increased the sample of patients covered. In this study, we update our previous publication in this area, after a follow-up of more than 5 years. An observational, descriptive, multicentre and ambispective study of adult and paediatric patients with haemoglobinopathies and rare anaemias registered in REHem was performed. The data are from a cross-sectional analysis performed on 1 June, 2023. The study population comprised 1,756 patients, of whom 1,317 had SCD, 214 had thalassaemia and 224 were diagnosed with another condition. Slightly more than one third of SCD patients (37%) were diagnosed based on neonatal bloodspot screening, and the mean age at diagnosis was 2.5 years; 71% of thalassaemia patients were diagnosed based on the presence of anaemia. Vaso-occlusive crisis and acute chest syndrome continue to be the most frequent complications in SCD. HSCT was performed in 83 patients with SCD and in 50 patients with thalassaemia. Since the previous publication, REHem-AR has grown in size by more than 500 cases. SCD and TM are less frequent in Spain than in other European countries, although the data show that rare anaemias are frequent within rare diseases. REHem-AR constitutes an important structure for following the natural history of rare anaemias and enables us to calculate investment needs for current and future treatments.

Hypothermia in the Combat Trauma Population.

BACKGROUND: The MARCH (Massive hemorrhage, Airway, Respirations, Circulation, and Hypothermia/Head injuries) algorithm taught to military medics includes interventions to prevent hypothermia. As possible sequelae from major trauma, hypothermia is associated with coagulopathy and lower survival. This paper sought to define hypothermia within our combat trauma population using an outcomes-based method, and determine clinical variables associated with hypothermia. METHODS: This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry focused on casualties who received prehospital care. A receiver operating curve was constructed and Youden's index was used to define hypothermia within the predetermined population based on mortality risk. A multivariable regression model was used to identify associations. RESULTS: There were 23,243 encounters that met the inclusion criteria for this study with patients having received prehospital care and documentation of at least one emergency department temperature. An optimal threshold of 36.2° C was found to predict mortality; 3,159 casualties had temperatures below this threshold (14%). Survival to discharge was lower among casualties with hypothermia (91% versus 98%). Hypothermic casualties were less likely to undergo blanket application (38% versus 40%). However, they had higher proportions with Hypothermia Prevention and Management Kit application (11% versus 7%) and radiant warming (2% versus 1%). On multivariable regression modeling, none of the hypothermia interventions were associated with a decreased likelihood of hypothermia. Non-hypothermia interventions associated with hypothermia included prehospital intubation (OR 1.57, 95% CI 1.45-1.69) and blood product administration. CONCLUSIONS: Hypothermia, including a single recorded low temperature in the patient care record, was associated with worse outcomes in this combat trauma population. Prehospital intubation was most strongly associated with developing hypothermia. Prehospital warming interventions were not associated with a reduction in hypothermia risk. Our dataset suggests that current methods for prehospital warming are inadequate.

A Retrospective Analysis of Combat Injury Patterns and Prehospital Interventions Associated with the Development of Sepsis.

BACKGROUND: Combat injury related wound infections are common. Untreated, these wound infections may progress to sepsis and septic shock leading to increased morbidity and mortality rates. Understanding infectious complications, patterns, progression, and correlated prehospital interventions are vital to understand the development of sepsis. We aim to analyze demographics, injury patterns, and interventions associated with sepsis in battlefield settings. MATERIALS AND METHODS: This is a secondary analysis of previously published data from the Department of Defense Trauma Registry (DoDTR) from 2007 to 2020. We searched for casualties diagnosed with sepsis (excluding line-sepsis) throughout their initial hospitalization. Regression models were used to seek associations. RESULTS: Our initial request yielded 28,950 encounters, of which 25,654 (88.6%) were adults that met inclusion, including 243 patients (0.9%) diagnosed with sepsis. Patients included US military (34%), non-North Atlantic Treaty Organization (NATO) military (33%) and humanitarian (30%) groups. Patients diagnosed with sepsis had a significantly lower survival rate than non-septic patients (78.1% vs. 95.7%, p < 0.001). There was no significant difference in administration of prehospital antibiotics between septic and the general populations (10.6% vs. 12.3%, p = 0.395). Prehospital intraosseous access (OR 1.56, 95% CI 1.27-1.91, p = 0.207) and packed red cell administration (1.63, 1.24-2.15, 0.029) were the interventions most associated with sepsis. CONCLUSIONS: Sepsis occurred infrequently in the DoDTR when evacuation from battlefield is not delayed, but despite increased intervention frequency, developing sepsis demonstrates a significant drop in survival rates. Future research would benefit from the development of risk mitigation measures.

How common is nerve injury after reverse shoulder arthroplasty? A systematic review.

BACKGROUND: Nerve injury following reverse shoulder arthroplasty (RSA) is a known risk factor with wide ranging incidences reported. This systematic review evaluates the overall incidence of nerve injury following primary and revision RSA and summarizes the characteristics of the nerve injuries reported in the current literature. METHODS: A systematic review was performed using separate database searches (Pubmed, Embase, Web of Science, Cochrane) following the PRISMA guidelines. Search criteria included the title terms "reverse shoulder," "reverse total shoulder," "inverted shoulder," and "inverted total shoulder" with publication dates ranging from 01/01/2010 to 01/01/2022. Studies that reported neurological injuries and complications were included and evaluated for primary RSA, revision RSA, number of nerve injuries, and which nerves were affected. RESULTS: After exclusion, our systematic review consisted of 188 articles. A total of 40,146 patients were included, with 65% female. The weighted mean age was 70.3 years. The weighted mean follow-up was 35.4 months. The rate of nerve injury after RSA was 1.3% (510 of 40,146 RSAs). The rate of injury was greater in revision RSA compared to primary RSA (2.4% vs. 1.3%). Nerve injury was most common in RSAs done for a primary diagnosis of acute proximal humerus fracture (4.0%), followed by cuff tear arthropathy (3.0%), DJD (2.6%), and inflammatory arthritis (1.7%). Massive rotator cuff tears and post-traumatic arthritis cases had the lowest nerve injury rates (1.0% and 1.4%, respectively). The axillary nerve was the most commonly reported nerve that was injured in both primary and revision RSA (0.6%), followed by the ulnar nerve (0.26%) and median nerve (0.23%). Brachial plexus injury was reported in 0.19% of overall RSA cases. CONCLUSION: Based on current English literature, nerve injuries occur at a rate of 1.3% after primary RSA compared with 2.4% after revision RSA. The most common nerve injury was to the axillary nerve (0.64%), with the most common operative diagnosis associated with nerve injury after RSA being acute proximal humerus fracture (4.0%). Surgeons should carefully counsel patients prior to surgery regarding the risk of nerve injury.

Supervisory Algorithm for Autonomous Hemodynamic Management Systems.

Future military conflicts will require new solutions to manage combat casualties. The use of automated medical systems can potentially address this need by streamlining and augmenting the delivery of medical care in both emergency and combat trauma environments. However, in many situations, these systems may need to operate in conjunction with other autonomous and semi-autonomous devices. Management of complex patients may require multiple automated systems operating simultaneously and potentially competing with each other. Supervisory controllers capable of harmonizing multiple closed-loop systems are thus essential before multiple automated medical systems can be deployed in managing complex medical situations. The objective for this study was to develop a Supervisory Algorithm for Casualty Management (SACM) that manages decisions and interplay between two automated systems designed for management of hemorrhage control and resuscitation: an automatic extremity tourniquet system and an adaptive resuscitation controller. SACM monitors the required physiological inputs for both systems and synchronizes each respective system as needed. We present a series of trauma experiments carried out in a physiologically relevant benchtop circulatory system in which SACM must recognize extremity or internal hemorrhage, activate the corresponding algorithm to apply a tourniquet, and then resuscitate back to the target pressure setpoint. SACM continues monitoring after the initial stabilization so that additional medical changes can be quickly identified and addressed, essential to extending automation algorithms past initial trauma resuscitation into extended monitoring. Overall, SACM is an important step in transitioning automated medical systems into emergency and combat trauma situations. Future work will address further interplay between these systems and integrate additional medical systems.

An index for multidimensional assessment of swine health.

Pork accounts for almost one-third of the meat consumed worldwide. Infectious diseases have a marked impact on pig production. Epidemiological indicators are considered the most useful criteria in decision-making; however, a health status assessment remains a challenge at the national and regional levels. This study proposes a health index including herd-losses, morbidity, fatality, and type of diseases, to rate the health situation in a region or country; it contributes to assessing the effectiveness of control, damage manifestation, and trends. It is a multidimensional index with a structure of triads and simple quantitative, semi-quantitative, and qualitative expressions that use flexible and dynamics limits. With it, we analyzed twenty-one countries in 2005-2018, focusing on African swine fever, classical swine fever, foot-mouth-disease, and porcine respiratory and reproductive syndrome, diseases that caused 72% of the morbidity. Our multidimensional approach estimates farm, local, and regional impact from infectious agents and outbreaks, and apprises trends aiming to be useful to control measures, strategic actions, and animal health policies.

Epigenetic footprint enables molecular risk stratification of hepatoblastoma with clinical implications.

BACKGROUND & AIMS: Hepatoblastoma (HB) is a rare disease. Nevertheless, it is the predominant pediatric liver cancer, with limited therapeutic options for patients with aggressive tumors. Herein, we aimed to uncover the mechanisms of HB pathobiology and to identify new biomarkers and therapeutic targets in a move towards precision medicine for patients with advanced HB. METHODS: We performed a comprehensive genomic, transcriptomic and epigenomic characterization of 159 clinically annotated samples from 113 patients with HB, using high-throughput technologies. RESULTS: We discovered a widespread epigenetic footprint of HB that includes hyperediting of the tumor suppressor BLCAP concomitant with a genome-wide dysregulation of RNA editing and the overexpression of mainly non-coding genes of the oncogenic 14q32 DLK1-DIO3 locus. By unsupervised analysis, we identified 2 epigenomic clusters (Epi-CA, Epi-CB) with distinct degrees of DNA hypomethylation and CpG island hypermethylation that are associated with the C1/C2/C2B transcriptomic subtypes. Based on these findings, we defined the first molecular risk stratification of HB (MRS-HB), which encompasses 3 main prognostic categories and improves the current clinical risk stratification approach. The MRS-3 category (28%), defined by strong 14q32 locus expression and Epi-CB methylation features, was characterized by CTNNB1 and NFE2L2 mutations, a progenitor-like phenotype and clinical aggressiveness. Finally, we identified choline kinase alpha as a promising therapeutic target for intermediate and high-risk HBs, as its inhibition in HB cell lines and patient-derived xenografts strongly abrogated tumor growth. CONCLUSIONS: These findings provide a detailed insight into the molecular features of HB and could be used to improve current clinical stratification approaches and to develop treatments for patients with HB. LAY SUMMARY: Hepatoblastoma is a rare childhood liver cancer that has been understudied. We have used cutting-edge technologies to expand our molecular knowledge of this cancer. Our biological findings can be used to improve clinical management and pave the way for the development of novel therapies for this cancer.

Leukocyte apoptosis, TNF-α concentration and oxidative damage in lead-exposed workers.

Lead intoxication can generate pro-inflammatory conditions that have been proposed to be associated with cell injuries and oxidative stress. The pro-inflammatory state can participate in the pathophysiology of this toxicity to generate immune response dysfunctions, which could condition the presence of clinical manifestations and susceptibility to infections already described in lead-exposed patients. In the present work, we study workers of a battery recycler factory (n = 24) who are chronically exposed to lead and compared them with non-lead exposed workers (n = 17). Lead-exposed workers had high lead concentrations in blood (med 69.8 vs. 1.7 µg/dL), low δ-ALAD activity (med 149 vs. 1100 nmol PBG/h/mL), high lipid peroxidation (med 0.86 vs. 0.69 nmol/mL) and high erythrocytes apoptosis (med 0.81 vs. 0.50% PS externalization) in relation to non-lead exposed workers. Also, lead-exposed workers had a high incidence of signs and symptoms related to lead intoxication and a higher frequency of infections. The higher leukocyte apoptosis (med 18.3 vs. 8.2% PS externalization) and lower basal TNF-α concentration (med 0.38 vs. 0.94 pg/mL) in lead-exposed workers imply an immune response dysfunction; however, there was no difference in the TNF-α concentration when leukocytes were stimulated with lipopolysaccharide in whole blood (med 44 vs. 70 pg/mL), suggesting that lead-exposed workers might develop adaptation mechanisms to reduce basal TNF-α release through downregulation processes proposed for this cytokine.

Participation of phospholipase-A2 and sphingomyelinase in the molecular pathways to eryptosis induced by oxidative stress in lead-exposed workers.

The increment of eryptosis in lead-exposed workers has been associated with oxidative stress, having as the main mediator [Ca2+]i. However, other molecules could participate as signals, such as PLA2 and SMase, which have been proposed to increase PGE2 and ceramides, both involved in the increment of PS externalization due to osmotic stress. To study the role of these enzymes in lead intoxication, we studied 30 lead exposed workers and 27 non-lead exposed individuals. We found, compared to non-exposed subjects, lead intoxication characterized by high blood lead concentration (median = 39.1 µg/dL), and low δ-ALAD activity (median = 348 nmol of porphobilinogen/h/mL); oxidative stress with high lipid peroxidation (median = 1.31 nmol of malondialdehyde/mL) and low TAC (median = 370 mM Trolox equivalents); a higher enzymatic activity of PLA2 (median = 518 AFU/mg) and SMase (median = 706 AFU/mg) and higher eryptosis (median = 0.92% PS externalization). Correlation and conditional probability analyses permit to associate oxidative stress and eryptosis with high PLA2 activity. However, high SMase activity was only associated with PLA2 activity. The role of these enzymes in the signal path to eryptosis induced by oxidative stress in lead-exposed workers is discussed.

[La analítica del aprendizaje en educación médica: ¿punto de inflexión?]

La analítica del aprendizaje es una disciplina novedosa que tiene un enorme potencial para mejorar la calidad de la educación médica y la evaluación del aprendizaje. Se define como: "la medición, recopilación, análisis y reporte de datos sobre los alumnos y sus contextos, con el propósito de entender y optimizar el aprendizaje y los entornos en que ocurre". En las últimas décadas, la aparición de grandes volúmenes de datos (big data), acompañada de una rápida evolución en la minería de datos educativos, la aparición de tecnologías sofisticadas para analizar y visualizar datos de cualquier tipo, así como la disponibilidad de dispositivos móviles con conectividad permanente, mayor velocidad de procesamiento y capacidad de recuperación de información, han generado un contexto que favorece el uso de la analítica del aprendizaje en la medicina clínica y la educación médica. En este artículo se describe la historia reciente del concepto de analítica del aprendizaje, sus ventajas y desventajas en educación superior, así como sus aplicaciones en la enseñanza de las ciencias de la salud y la evaluación educativa. Es necesario que la comunidad de educadores médicos conozca la analítica del aprendizaje, para ser capaces de integrarla en su contexto eficaz y oportunamente.

Learning analytics is an innovative discipline that has an enormous potential to improve the quality of medical education and learning assessment. It is defined as: "the measurement, collection, analysis and reporting of data about learners and their contexts, for purposes of understanding and optimizing learning and the environments in which it occurs". In recent decades, the appearance of large volumes of data (big data), accompanied by a quick evolution of educational data mining techniques, the emergence of sophisticated technologies to analyze and visualize any type of data, as well as the availability of permanently-connected mobile electronic devices, higher processing speed and capacity of information retrieval, have generated a context that favors the use of learning analytics in clinical medicine and medical education. In this paper, the recent history of the concept of learning analytics is described, as well as its advantages and disadvantages in higher education, and its applications in the teaching of health sciences and educational assessment. It is necessary for the community of medical educators to be acquainted with learning analytics, in order to be able to integrate it to our context in an efficacious and timely manner.

Eryptosis and oxidative damage in hypertensive and dyslipidemic patients.

Arterial hypertension is a disease that often coexists with dyslipidemia. Both disorders can produce oxidative stress. Studies in vivo and in vitro have proven that oxidative stress can induce an increment of the erythrocyte apoptosis (eryptosis), through the rise of free intracellular calcium concentration ([Ca2+]i). Higher levels of eryptosis have not been described in patients with hypertension, dyslipidemia, or both combined. This study involved 81 men between 26 and 50 years old, assorted into four groups: normotensive with and without dyslipidemia, and hypertensive with and without dyslipidemia. Hypertensive and/or dyslipidemic patients had double mean lipid peroxidation and 30% less mean GSH concentration than the normotensive non-dyslipidemic patients. Mean [Ca2+]i in hypertensive patients was 100 and 200% higher, in patients without and with dyslipidemia, respectively, compared to normotensive patients. Dyslipidemic normotensive patients had three times higher mean PS externalization than the normotensive non-dyslipidemic patients, and the hypertension condition doubled this difference. Hypertensive patients had higher eryptosis associated with higher levels of [Ca2+]i and oxidative stress, suggesting that eryptosis participates in the pathophysiological mechanisms of hypertension. The quantitative analysis, when the dyslipidemic factor is included, shows that oxidative stress-[Ca2+]i-eryptosis do not follow a unique pattern in the different groups and suggests the existence of mechanisms of induction and molecular pathways alternative or additional to oxidative stress and [Ca2+]i, respectively.

Psychometric Properties of the Spanish Version of the Sexual Inhibition/Sexual Excitation Scales for Men.

The dual control model (DCM) postulates the involvement of relatively independent inhibitory and excitatory systems, which together provide a "double control" over sexual response and associated behavior (Janssen & Bancroft, 2007). Based on this model, the Sexual Inhibition and Sexual Excitation Scales assess the propensity for sexual excitation and sexual inhibition. This research focused on analyzing some psychometric properties of this questionnaire and developing a Spanish version in men. The sample consisted of 823 heterosexual men of ages ranging from 18 to 74 years. Confirmatory factor analysis generated a version of the scale that consisted of 34 items (11 items with the worst factor loadings were eliminated) distributed in four factors (one sexual excitation factor and three sexual inhibition factors). This is consistent with the DCM of sexual response. The four factors demonstrated good reliability coefficients except for sexual inhibition due to the threat of performance consequences, which was found to have a low internal consistency. Consequently, this is something that will be addressed in future studies. The four factors were found to have good test-retest reliability. The measures of the Sexual Inhibition and Sexual Excitation Scales had good validity properties and a coherent relationship with sexual sensation seeking and erotophilia.

Differences in the prevalence of depression in older Spanish Romany and non-Romany people and associated factors.

AIM: Depression among older adults has serious implications, especially because suicide rates are higher in this group than in younger adults. Research has identified biological and social risk factors. However, studies addressing cultural and psychosocial factors associated with specific ethnic groups, such as Spanish Romani, are lacking. The objective of the present study was to establish the differential prevalence of depression among Romany and non-Romany people older than 55 years of age. It also aimed to explore how cultural, sociodemographic, and psychosocial factors predispose individuals to depression. METHODS: A total of 181 people were interviewed. The sample consisted of 95 self-adscribed Romany individuals and 86 non-Romany individuals over the age of 55; the latter group served as the control group. We performed bifactorial univariate anova, epidemiological analysis using Epi Info software, and analysis of correlations between Geriatric Depression Scale scores and the different factors analyzed. RESULTS: Significant differences in Geriatric Depression Scale score related to ethnicity and sex were found. Probable depression or depression in Romany men was four times higher than in non-Romany men. In Romany women, the risk was more than twice as high as in non-Romany women. Among the factors analyzed, income level, activity at home, and perception of being valued by family members showed significant differences between the groups. CONCLUSIONS: In short, we can state that Romany people develop symptoms of depression to a greater extent than non-Romany people, and although Romany women have a higher risk of depression, the differential effect of ethnicity is greater among Romany men. Income level, activity at home, and perception of being valued by family members are unambiguously related to ethnicity.

Diagnostic accuracy of a novel software technology for detecting pneumothorax in a porcine model.

INTRODUCTION: Our objective was to measure the diagnostic accuracy of a novel software technology to detect pneumothorax on Brightness (B) mode and Motion (M) mode ultrasonography. METHODS: Ultrasonography fellowship-trained emergency physicians performed thoracic ultrasonography at baseline and after surgically creating a pneumothorax in eight intubated, spontaneously breathing porcine subjects. Prior to pneumothorax induction, we captured sagittal M-mode still images and B-mode videos of each intercostal space with a linear array transducer at 4cm of depth. After collection of baseline images, we placed a chest tube, injected air into the pleural space in 250mL increments, and repeated the ultrasonography for pneumothorax volumes of 250mL, 500mL, 750mL, and 1000mL. We confirmed pneumothorax with intrapleural digital manometry and ultrasound by expert sonographers. We exported collected images for interpretation by the software. We treated each individual scan as a single test for interpretation by the software. RESULTS: Excluding indeterminate results, we collected 338M-mode images for which the software demonstrated a sensitivity of 98% (95% confidence interval [CI] 92-99%), specificity of 95% (95% CI 86-99), positive likelihood ratio (LR+) of 21.6 (95% CI 7.1-65), and negative likelihood ratio (LR-) of 0.02 (95% CI 0.008-0.046). Among 364 B-mode videos, the software demonstrated a sensitivity of 86% (95% CI 81-90%), specificity of 85% (81-91%), LR+ of 5.7 (95% CI 3.2-10.2), and LR- of 0.17 (95% CI 0.12-0.22). CONCLUSIONS: This novel technology has potential as a useful adjunct to diagnose pneumothorax on thoracic ultrasonography.

Use of an Ecological Model to Study Sexual Satisfaction in a Heterosexual Spanish Sample.

Sexual satisfaction is a key factor in sexual health and has been associated with quality of life. However, few studies have focused on the factors related to sexual satisfaction in the population in Spain. The main goal of this research was to analyze the predictive capacity of an ecological model for the study of sexual satisfaction in a Spanish sample of 723 men and 851 women, with mean age equal to 36.28 (SD = 12.59) and who were in a heterosexual relationship. We analyzed, using structural equation modeling, the degree to which sexual satisfaction was related to different variables. These variables were the following: personal variables (depression and sexual attitudes); interpersonal variables (relationship satisfaction, sexual function, and sexual assertiveness); social variables (social support, parenthood, and annual income); and cultural variables (political ideology, religion, and religious practice). In men, sexual satisfaction was directly predicted by relationship satisfaction and sexual function. Furthermore, political ideology, religious practice, social support, annual income, initiation sexual assertiveness, and sexual attitudes were indirectly associated with sexual satisfaction. In women, sexual satisfaction was directly predicted by relationship satisfaction, sexual function, sexual assertiveness, and sexual attitudes. In addition, political ideology, religious practice, and social support were indirectly associated with sexual satisfaction. Implications for research and therapy are also discussed.

A fuzzy Bayesian approach to flood frequency estimation with imprecise historical information.

This paper presents a novel framework that links imprecision (through a fuzzy approach) and stochastic uncertainty (through a Bayesian approach) in estimating flood probabilities from historical flood information and systematic flood discharge data. The method exploits the linguistic characteristics of historical source material to construct membership functions, which may be wider or narrower, depending on the vagueness of the statements. The membership functions are either included in the prior distribution or the likelihood function to obtain a fuzzy version of the flood frequency curve. The viability of the approach is demonstrated by three case studies that differ in terms of their hydromorphological conditions (from an Alpine river with bedrock profile to a flat lowland river with extensive flood plains) and historical source material (including narratives, town and county meeting protocols, flood marks and damage accounts). The case studies are presented in order of increasing fuzziness (the Rhine at Basel, Switzerland; the Werra at Meiningen, Germany; and the Tisza at Szeged, Hungary). Incorporating imprecise historical information is found to reduce the range between the 5% and 95% Bayesian credibility bounds of the 100 year floods by 45% and 61% for the Rhine and Werra case studies, respectively. The strengths and limitations of the framework are discussed relative to alternative (non-fuzzy) methods. The fuzzy Bayesian inference framework provides a flexible methodology that fits the imprecise nature of linguistic information on historical floods as available in historical written documentation.

[Assessment of the concentrations of carbonylated proteins and carbonyl reductase enzyme in mexican women with breast cancer: A pilot study]. / Determinación de proteínas carboniladas y enzima carbonil reductasa en mujeres mexicanas con cáncer de mama: estudio piloto.

Oxidative stress could promote the development of cancer and implicate carbonylated proteins in the carcinogenic process. The goal of this study was to assess the concentrations of carbonylated proteins and carbonyl reductase enzyme in women with breast cancer and determine whether these markers were possible indicators of tissue damage caused by the disease. A total of 120 healthy women and 123 women with a diagnosis of breast cancer were included. The concentration of carbonylated proteins in plasma and the concentration of carbonyl reductase enzyme in leukocytes were determined using the ELISA assay. There was a 3.76-fold increase in the amount of carbonylated proteins in the plasma from the patient group compared with healthy control group (5±3.27 vs. 1.33±2.31 nmol carbonyls/mg protein; p<0.05). Additionally, a 60% increase in the carbonyl reductase enzyme was observed in the patient group compared with the healthy control group (3.27±0.124 vs. 2.04±0.11 ng/mg protein; p<0.05). A positive correlation (r=0.95; p<0.001) was found between both measurements. These results suggest the presence of tissue damage produced by cancer; therefore, these parameters could be used to indicate tissue damage in cancer patients.

Antibody profile to Borrelia burgdorferi in veterinarians from Nuevo León, Mexico, a non-endemic area of this zoonosis.

OBJECTIVES: Lyme disease is a tick-borne disease caused by infections with Borrelia. Persons infected with Borrelia can be asymptomatic or can develop disseminated disease. Diagnosis and recognition of groups at risk of infection with Borrelia burgdorferi is of great interest to contemporary rheumatology. There are a few reports about Borrelia infection in Mexico, including lymphocytoma cases positive to B. burgdorferi sensu stricto by PCR and a patient with acrodermatitis chronica atrophicans. Veterinarians have an occupational risk due to high rates of tick contact. The aim of this work was to investigate antibodies to Borrelia in students at the Faculty of Veterinary Medicine and Zootechnics, at Nuevo León, Mexico, and determine the antibody profile to B. burgdorferi antigens. MATERIAL AND METHODS: Sera were screened using a C6 ELISA, IgG and IgM ELISA using recombinant proteins from B. burgdorferi, B. garinii and B. afzelii. Sera with positive or grey-zone values were tested by IgG Western blot to B. burgdorferi sensu stricto. RESULTS: All volunteers reported tick exposures and 72.5% remembered tick bites. Only nine persons described mild Lyme disease related symptoms, including headaches, paresthesias, myalgias and arthralgias. None of the volunteers reported erythema migrans. Nine samples were confirmed by IgG Western blot. The profile showed 89% reactivity to OspA, 67% to p83, and 45% to BmpA. CONCLUSIONS: Positive sera samples shared antibody reactivity to the markers of late immune response p83 and BmpA, even if individuals did not present symptoms of Lyme arthritis or post-Lyme disease. The best criterion to diagnose Lyme disease in our country remains to be established, because it is probable that different strains coexist in Mexico. This is the first report of antibodies to B. burgdorferi in Latin American veterinarians. Veterinarians and high-risk people should be alert to take precautionary measures to prevent tick-borne diseases.