[Strength training education for physicians increases its prescription]. / La formación en entrenamiento de fuerza dirigida a médicos aumenta su prescripción.

INTRODUCTION: Medical prescriptions have traditionally been focused on aerobic exercise. However, an increasing number of authors are pointing towards strength training as the healthiest exercise modality. The purpose of this study is to assess whether physicians increase their knowledge as well as their confidence to prescribe strength training after attending a physical training course. MATERIALS AND METHODS: A prospective cohort study of 160 physicians was conducted, 80 physicians out of the 160 attended a physical training course, whereas the remaining 80 physicians did not. Personal and professional data was collected, as well as data regarding the type of exercise they were practising or prescribing and the confidence and knowledge for their prescription. Finally, differences between the two groups and the impact of attending the course where analysed. RESULTS: Both groups were homogeneous in gender, age, medical speciality and practice of physical exercise, with very low rates of strength training and prescription for both groups. It was established that the group attending the course acquired knowledge and confidence for prescribing strength training. Moreover, this group considered that strength training was the exercise modality which should be encouraged (P<.001). CONCLUSIONS: Education in strength training for physicians by means of a theoretical-practical course increases knowledge and confidence for its prescription.

Development of an Anti-Acinetobacter baumannii Biofilm Phage Cocktail: Genomic Adaptation to the Host.

The need for alternatives to antibiotic therapy due to the emergence of multidrug resistant bacteria (MDR), such as the nosocomial pathogen Acinetobacter baumannii, has led to the recovery of phage therapy. In addition, phages can be combined in cocktails to increase the host range. In this study, the evolutionary mechanism of adaptation was utilized in order to develop a phage adapted to A. baumannii, named phage Ab105-2phiΔCI404ad, from a mutant lytic phage, Ab105-2phiΔCI, previously developed by our group. The whole genome sequence of phage Ab105-2phiΔCI404ad was determined, showing that four genomic rearrangements events occurred in the tail morphogenesis module affecting the ORFs encoding the host receptor binding sites. As a consequence of the genomic rearrangements, 10 ORFs were lost and four new ORFs were obtained, all encoding tail proteins; two inverted regions were also derived from these events. The adaptation process increased the host range of the adapted phage by almost 3-fold. In addition, a depolymerase-expressing phenotype, indicated by formation of a halo, which was not observed in the ancestral phage, was obtained in 81% of the infected strains. A phage cocktail was formed by combining this phage with the A. baumannii phage vB_AbaP_B3, known to express a depolymerase. Both the individual phages and the phage cocktail showed strong antimicrobial activity against 5 clinical strains and 1 reference strain of A. baumannii tested. However, in all cases resistance to the bacterial strains was also observed. The antibiofilm activity of the individual phages and the cocktail was assayed. The phage cocktail displayed strong antibiofilm activity.

[Low-cost virtual reality. A new application for upper extremity motor rehabilitation in neurological pathology: Pilot study]. / Realidad virtual de bajo coste. Una nueva aplicación para rehabilitación motora de los miembros superiores en patología neurológica: Estudio piloto.

BACKGROUND AND OBJECTIVES: The aim of this study is to present a new virtual reality (VR) low cost application based on Leap Motion Controller (LMC) device for upper extremity motor rehabilitation after neurological pathology and to demonstrate its clinical feasibility by carrying out a pilot experience. MATERIAL AND METHODS: The LMC allows the interaction with virtual applications by capturing the patient's hand movements. A pilot study was carried out with 4 patients with upper limb impairment reflected with Upper Extremity Motor Score (UEMS) greater than 10. They were assessed using the Box and Block (BBT) and the writing task within the Jebsen-Taylor Hand Function (JTHF) before and after the intervention. RESULTS: All patients completed the 9-session, 30-min protocol divided into 3 sessions per week. They went from an average result of 38 (SD 20) blocks in BBT before the intervention to 44 (SD 21.72) after it. They went from 28.25 s (SD 8.61) to 26.75 s (SD 21.72) in the JTHF. Statistically significant differences were no found. The device usability was assessed by the QUEST scale, being the security, effectiveness and ease to use the aspects that patients considered to be a priority. CONCLUSIóN: A new VR development based on the LMC device is presented and the clinical feasibility of its application in neurological patients with upper limb involvement has been proven. A clinical study with a large sample size is needed to assess its potential clinical effectiveness as a treatment element.

Unveiling the Atomic and Electronic Structure of Stacked-Cup Carbon Nanofibers.

We report results of comprehensive experimental exploration (X-ray photoemission, Raman and optical spectroscopy) of carbon nanofibers (CNFs) in combination with first-principles modeling. Core-level spectra demonstrate prevalence of sp2 hybridization of carbon atoms in CNF with a trace amount of carbon-oxygen bonds. The density functional theory (DFT)-based calculations demonstrated no visible difference between mono- and bilayers because σ-orbitals are related to in-plane covalent bonds. The influence of the distortions on π-peak is found to be significant only for bilayers as a result of π-π interlayer bonds formation. These results are supported by both experimental Raman and XPS valence band spectra. The combination of optical measurements with a theoretical modeling indicates the formation of optically active graphene quantum dots (GQDs) in the CNF matrix, with a radiative relaxation of the excited π* state. The calculated electronic structure of these GQDs is in quantitative agreement with the measured optical transitions and provides an explanation of the absence of visible contribution from these GQDs to the measured valence bands spectra.

[Syndrome of the trephined]. / Síndrome del trefinado.

Syndrome of the trephined (SoT) is the neurological deterioration that occurs after the performance of decompressive craniectomy in which bone is not replaced. The incidence of SoT varies, but this entity seems to be underdiagnosed. It is characterized by symptom reversal after bone replacement, which is the only definitive treatment. We report the case of a patient assessed by the Rehabilitation Service in the Critical Care Unit after a stroke, who had altered level of consciousness and abrupt motor impairment. The patient was diagnosed with SoT. Rehabilitation, with early postural changes, helped to ameliorate the symptoms until the provision of definitive treatment.

[Fighting against COVID-19: clinical activities of spanish rehabilitation physicians: A cross-sectional study]. / Luchando contra la COVID-19: labor asistencial de los médicos rehabilitadores españoles. Estudio transversal.

OBJECTIVE: The aim of this study was to analyse both the impact of the pandemic and clinical and teaching organisation in Spanish Physical Medicine and Rehabilitation Departments during the COVID-19 pandemic. METHODS: A survey was conducted of the tutors of rehabilitation departments. The questionnaire contained 31 questions divided into 6 parts about the following: general information on the department, adaptation of rehabilitation departments to the COVID pandemic, clinical work of rehabilitation physicians, the approach to rehabilitation in COVID patients, and the effects of the pandemic on the health and teaching activity of rehabilitation physicians during this period. RESULTS: A total of 54 responses were obtained. Almost half of the departments cancelled face-to-face medical consultations (40%) and 48% of the treatment rooms were turned into COVID beds. In 30 hospitals (55.6%), the physicians worked in COVID units. Most of the rehabilitation departments developed both graphic and audiovisual material with exercises, referral protocols and guidelines for the rehabilitation management and treatment of COVID 19 patients. Half of the departments reported some anxiety symptoms in medical staff. Tutorial work has been cancelled (40.7%) or reduced (35.2%). CONCLUSIONS: The organisation of Spanish rehabilitation departments in response to the COVID pandemic has been very similar throughout the country. The response of these departments to the healthcare crisis has revealed the versatility of rehabilitation physicians.

Toxins of toxin/antitoxin systems are inactivated primarily through promoter mutations.

AIMS: Given the extreme toxicity of some of the toxins of toxin-antitoxin (TA) systems, we were curious how the cell silences toxins, if the antitoxin is inactivated or independent toxins are obtained via horizontal gene transfer. METHODS AND RESULTS: Growth curves of Escherichia coli K12 BW25113 harbouring plasmid pCA24N to produce RalR, MqsR, GhoT or Hha toxins, showed toxin inactivation after 3 h. Sequencing plasmids from these cultures revealed toxin inactivation occurred primarily due to consistent deletions in the promoter. The lack of mutation in the structural genes was corroborated by a bioinformatics analysis of 1000 E. coli genomes which showed both conservation and little variability in the four toxin genes. For those strains that lacked a mutation in the plasmid, single nucleotide polymorphism analysis was performed to identify that chromosomal mutations iraM and mhpR inactivate the toxins GhoT and MqsR/GhoT respectively. CONCLUSION: We find that the RalR (type I), MqsR (type II), GhoT (type V) and Hha (type VII) toxins are inactivated primarily by a mutation that inactivates the toxin promoter or via the chromosomal mutations iraM and mhpR. SIGNIFICANCE AND IMPACT OF THE STUDY: This study demonstrates toxins of TA systems may be inactivated by mutations that primarily affect the toxin gene promoter instead of the toxin structural gene.

[Conservative management of traumatic priapism in paediatric patients]. / Manejo conservador del priapismo traumático en la edad pediátrica.

INTRODUCTION: High-flow priapism is infrequent in pediatric patients. It is mostly secondary to perineal trauma resulting in laceration of a penile artery and the formation of an arterio-cavernous fistula. It does not constitute a medical emergency in itself, and allows conservative management awaiting spontaneous resolution. CLINICAL CASE: A six-year-old boy with painless persistent erection preceded by perineal trauma. Ultrasound imaging confirmed the clinical suspicion of high flow priapism secondary to arterio-cavernous fistula. After adopting a conservative approach, the patient presented progressive detumescence, as well as ultrasound resolution one month after the episode. COMMENTS: In high-flow priapism, venous drainage of the penis is preserved. The classical approach in adults is based on therapeutic angiography, which presents greater technical complexity and the risk of iatrogenic hypoxia in pediatric patients.

INTRODUCCION: El priapismo de alto flujo es una entidad infrecuente en la edad pediátrica. Es, en su mayoría, secundario a traumatismo perineal que provoca la laceración de una arteria peneana y formación de una fístula arterio-cavernosa. No constituye una emergencia médica, permitiendo un manejo conservador a la espera de su resolución espontánea. CASO CLINICO: Niño de seis años con erección persistente e indolora tras traumatismo perineal. El diagnóstico ecográfico confirma la sospecha de priapismo de alto flujo secundario a fístula arteria-cavernosa. Tras manejo conservador, presenta detumescencia progresiva y resolución ecográfica al mes del episodio. COMENTARIOS: En el priapismo de alto flujo el drenaje venoso del pene se encuentra conservado. El manejo clásico en adultos se fundamenta en la angiografía terapéutica, de mayor complejidad técnica y riesgo de hipoxia iatrogénica en el paciente pediátrico.

Mechanisms of Bacterial Tolerance and Persistence in the Gastrointestinal and Respiratory Environments.

Pathogens that infect the gastrointestinal and respiratory tracts are subjected to intense pressure due to the environmental conditions of the surroundings. This pressure has led to the development of mechanisms of bacterial tolerance or persistence which enable microorganisms to survive in these locations. In this review, we analyze the general stress response (RpoS mediated), reactive oxygen species (ROS) tolerance, energy metabolism, drug efflux pumps, SOS response, quorum sensing (QS) bacterial communication, (p)ppGpp signaling, and toxin-antitoxin (TA) systems of pathogens, such as Escherichia coli, Salmonella spp., Vibrio spp., Helicobacter spp., Campylobacter jejuni, Enterococcus spp., Shigella spp., Yersinia spp., and Clostridium difficile, all of which inhabit the gastrointestinal tract. The following respiratory tract pathogens are also considered: Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, Burkholderia cenocepacia, and Mycobacterium tuberculosis Knowledge of the molecular mechanisms regulating the bacterial tolerance and persistence phenotypes is essential in the fight against multiresistant pathogens, as it will enable the identification of new targets for developing innovative anti-infective treatments.

Evolution of the Quorum network and the mobilome (plasmids and bacteriophages) in clinical strains of Acinetobacter baumannii during a decade.

In this study, we compared eighteen clinical strains of A. baumannii belonging to the ST-2 clone and isolated from patients in the same intensive care unit (ICU) in 2000 (9 strains referred to collectively as Ab_GEIH-2000) and 2010 (9 strains referred to collectively as Ab_GEIH-2010), during the GEIH-REIPI project (Umbrella BioProject PRJNA422585). We observed two main molecular differences between the Ab_GEIH-2010 and the Ab_GEIH-2000 collections, acquired over the course of the decade long sampling interval and involving the mobilome: i) a plasmid harbouring genes for blaOXA 24/40 ß-lactamase and abKA/abkB proteins of a toxin-antitoxin system; and ii) two temperate bacteriophages, Ab105-1ϕ (63 proteins) and Ab105-2ϕ (93 proteins), containing important viral defence proteins. Moreover, all Ab_GEIH-2010 strains contained a Quorum functional network of Quorum Sensing (QS) and Quorum Quenching (QQ) mechanisms, including a new QQ enzyme, AidA, which acts as a bacterial defence mechanism against the exogenous 3-oxo-C12-HSL. Interestingly, the infective capacity of the bacteriophages isolated in this study (Ab105-1ϕ and Ab105-2ϕ) was higher in the Ab_GEIH-2010 strains (carrying a functional Quorum network) than in the Ab_GEIH-2000 strains (carrying a deficient Quorum network), in which the bacteriophages showed little or no infectivity. This is the first study about the evolution of the Quorum network and the mobilome in clinical strains of Acinetobacter baumannii during a decade.

Genomic Evolution of Two Acinetobacter baumannii Clinical Strains from ST-2 Clones Isolated in 2000 and 2010 (ST-2_clon_2000 and ST-2_clon_2010).

Acinetobacter baumannii is a successful nosocomial pathogen due to its ability to persist in hospital environments by acquiring mobile elements such as transposons, plasmids, and phages. In this study, we compared two genomes of A. baumannii clinical strains isolated in 2000 (ST-2_clon_2000) and 2010 (ST-2_clon_2010) from GenBank project PRJNA308422.

Genome Sequence of a Clinical Strain of Acinetobacter baumannii Belonging to the ST79/PFGE-HUI-1 Clone Lacking the AdeABC (Resistance-Nodulation-Cell Division-Type) Efflux Pump.

Increased expression of chromosomal genes for resistance-nodulation-cell division-type efflux systems plays a major role in the multidrug resistance of Acinetobacter baumannii Little is known about the genetic characteristics of clinical strains of Acinetobacter baumannii lacking the AdeABC pump. In this study, we sequenced the genome of clinical strain Ab421 GEIH-2010 (belonging to clone ST79/PFGE-HUI-1 from the GEIH-REIPI Ab. 2010 project) which lacks this efflux pump.

[Infantile hypertrofic pyloric stenosis or gastric adenomyoma? Differential diagnosis of gastric outlet obstruction in children]. / ¿Estenosis hipertrófica de píloro o adenomioma pilórico? Diagnóstico diferencial de obstrucción gástrica en niños.

PURPOSE: Gastrointestinal adenomyoma is a rare benign tumor most frequently located in the stomach. The differential diagnosis is wide because of its large clinical spectrum and unspecific radiological findings. Surgical excision is both diagnostic and therapeutic. CASE REPORT: A 49-days old girl presented with nonbilious vomiting of 48 hours of evolution. Infantile hypertrofic pyloric stenosis was suspected. Ultrasound showed a nonobstructive nodular lesion in the anterior pyloric wall. MRI suggested a myofibroblastic tumor. We proceeded to laparotomy and complete resection of the pyloric tumor. Histologic diagnosis was gastric adenomyoma. CONCLUSIONS: Pyloric adenomyoma causes obstructive symptoms similar to other common entities such as hypertrophic pyloric stenosis or cystic duplication. We have to consider this condition in children with digestive symptoms and radiological images of intussusceptions or duplication. Surgical excision is recommended to reach a definitive diagnosis and to avoid a possible malignant degeneration.

INTRODUCCION: El adenomioma gastrointestinal es una tumoración benigna rara cuya localización más frecuente es gástrica. Su diagnóstico diferencial es amplio debido a su gran espectro clínico y baja especificidad radiológica. La escisión quirúrgica es diagnóstico-terapeútica. CASO CLINICO: Niña de 49 días que presenta vómitos no biliosos de 48 horas de evolución. Ante sospecha de estenosis hipertrófica de píloro se solicita ecografía que muestra lesión nodular no obstructiva en pared anterior del píloro. Se realiza RM sugestiva de tumor miofibroblástico. Se procede a laparotomía y resección completa de tumoración pilórica, informada histológicamente como adenomioma gástrico. COMENTARIOS: El adenomioma pilórico produce clínica obstructiva y se confunde con entidades comunes como la estenosis hipertrófica de píloro o la duplicación quística. En un niño con síntomas digestivos e imagen radiológica de invaginación o duplicación, debemos tener en cuenta esta patología. La resección quirúrgica es de elección para un diagnóstico certero y para evitar una posible degeneración maligna.

[Compressive anterior thoracoplasty (modified Abramson's repair) for pectus carinatum repair]. / Toracoplastia anterior compresiva (técnica de Abramson modificada) para el tratamiento del pectus carinatum.

OBJECTIVES: For anterior protruding chest wall deformities treatment, mainly pectus carinatum, pediatric surgeons have been managing either orthotic methods or open surgical repairs. Anterior compressive thoracoplasty (Abramson's technique) has widened the therapeutic options. We describe herein a modification of this technique in the first reported Europen series. PATIENTS AND METHODS: From 2010 to 2012, a total of five patients (four male and one female) underwent a modified Abramson's technique to correct pectus carinatum or combined protrusion of the chest at our center. We report the operative technique used for these reconstructions. RESULTS: In all five cases, the operation was completed uneventfully and with excellent results either for the surgical team or the patients. Mean operative time was 190 minutes and hospitalization lasted for three to six days, at the time of analgesic drugs withdrawal. CONCLUSIONS: We consider the anterior compresive thorocoplasty (modified Abramson's technique) a safe and feasible method to correct protruding chest deformities, particularly in those patients with stiff chest or lack of compliance, in order to avoid the agressive open procedures.

INTRODUCCION: Entre las opciones terapéuticas para las deformidades anteriores del tórax, la cirugía pediátrica ha dispuesto de tratamientos ortóticos y de técnicas quirúrgicas "abiertas". La toracoplastia compresiva anterior se une a las anteriores y amplía las opciones terapéuticas. Se describe aquí esta técnica en lo que supone la primera serie europea comunicada. MATERIAL Y METODOS: Revisión retrospectiva de las toracoplastias por técnica de Abramson modificada para el tratamiento del pectus carinatum y protrusiones costales en nuestro servicio entre 2010 y 2012. Descripción de la técnica a partir de los primeros cinco casos completados de nuestra serie, cuatro varones y una mujer, con edades entre los 13 y los 19 años. RESULTADOS: En todos los casos la técnica se ha podido completar sin complicaciones intra o perioperatorias y con resultados excelentes, tanto para el equipo quirúrgico como para los pacientes. El tiempo operatorio medio ha sido de 190 minutos y el alta hospitalaria se ha conseguido entre los tres y seis días después de la intervención, una vez completado el control analgésico. CONCLUSIONES: Consideramos que la toracoplastia compresiva anterior es una técnica mínimamente invasiva para la corrección del pectus carinatum y deformidades afines que resulta particularmente útil en los casos en los que la rigidez del tórax impide la adopción de tratamientos ortopédicos, en casos de no aceptación del tratamiento ortótico o cuando la cirugía convencional se considera demasiado agresiva.

Osteoclastoid giant cell carcinoma of the pancreas.

Osteoclastoid (osteoclast-like) giant cell carcinoma of the pancreas is an infrequent entity. There has long been discussion concerning its epithelial or mesenchymal origin. Whether its prognosis is better than that of other exocrine tumours of the pancreas has not yet been established. We present a case of this rare entity. The patient has remained disease-free now for 30 months.

Agenesis of the gallbladder confirmed by nuclear magnetic resonance cholangiogram.

We present a case of gallbladder agenesis, an uncommon bile duct malformation, which was found on attempting to perform a laparoscopic cholecystectomy. The diagnosis was confirmed postoperatively on a nuclear magnetic resonance cholangiogram.

[Urethral foreign bodies. Apropos 2 cases]. / Cuerpos extraños de uretra. A propósito de dos casos.

OBJECTIVE: To report two cases of urethral foreign body. Although this condition is not uncommon, few cases are reported in the literature. METHODS/RESULTS: Two cases of urethral foreign body are described: a 74-year-old male with mental disorder who presented with acute urinary retention arising from a fragment of a metal tube in the bulbous urethra and a 34-year-old female with intense micturition syndrome arising from a calcified electrical cable located in the urethra. Both patients required open surgery for foreign body removal. CONCLUSIONS: A wide variety of urethral foreign body has been described in the literature. In adults this is commonly caused by the insertion of objects used for masturbation and is frequently associated with mental disorder as in the two cases described herein.