Gastric lymphangioma. Diagnosis by endoscopic resection of a foreign entity.

The lymphangioma is a rare and very uncommon benign tumor at the gastric level. Its diagnosis typically involves imaging tests and endoscopy, and its treatment usually involves surgery. We present a case of an 82-year-old patient who presented with chronic anemia, with a large gastric polyp detected during the initial gastroscopy. Subsequently, an endoscopic resection was performed, confirming histologically that it was a lymphangioma.

The Reprimo-Like Gene Is an Epigenetic-Mediated Tumor Suppressor and a Candidate Biomarker for the Non-Invasive Detection of Gastric Cancer.

Reprimo-like (RPRML) is an uncharacterized member of the Reprimo gene family. Here, we evaluated the role of RPRML and whether its regulation by DNA methylation is a potential non-invasive biomarker of gastric cancer. RPRML expression was evaluated by immunohistochemistry in 90 patients with gastric cancer and associated with clinicopathologic characteristics and outcomes. The role of RPRML in cancer biology was investigated in vitro, through RPRML ectopic overexpression. Functional experiments included colony formation, soft agar, MTS, and Ki67 immunofluorescence assays. DNA methylation-mediated silencing was evaluated by the 5-azacytidine assay and direct bisulfite sequencing. Non-invasive detection of circulating methylated RPRML DNA was assessed in 25 gastric cancer cases and 25 age- and sex-balanced cancer-free controls by the MethyLight assay. Downregulation of RPRML protein expression was associated with poor overall survival in advanced gastric cancer. RPRML overexpression significantly inhibited clonogenic capacity, anchorage-independent growth, and proliferation in vitro. Circulating methylated RPRML DNA distinguished patients with gastric cancer from controls with an area under the curve of 0.726. The in vitro overexpression results and the poor patient survival associated with lower RPRML levels suggest that RPRML plays a tumor-suppressive role in the stomach. Circulating methylated RPRML DNA may serve as a biomarker for the non-invasive detection of gastric cancer.

Cardiac arrhythmias after renal I/R depend on IL-1ß.

AIMS: Cardiac arrhythmias are one of the most important remote complications after kidney injury. Renal ischemia reperfusion (I/R) is a major cause of acute renal injury predisposing to several remote dysfunctions, including cardiac electrical disturbance. Since IL-1ß production dependent on NLRP3 represents a link between tissue malfunctioning and cardiac arrhythmias, here we tested the hypothesis that longer ventricular repolarization and arrhythmias after renal I/R depend on this innate immunity sensor. METHODS AND RESULTS: Nlrp3-/- and Casp1-/- mice reacted to renal I/R with no increase in plasma IL-1ß, different from WT (wild-type) I/R. A prolonged QJ interval and an increased susceptibility to ventricular arrhythmias were found after I/R compared to Sham controls in wild-type mice at 15 days post-perfusion, but not in Nlrp3-/- or CASP1-/- I/R, indicating that the absence of NLRP3 or CASP1 totally prevented longer QJ interval after renal I/R. In contrast with WT mice, we found no renal atrophy and no renal dysfunction in Nlrp3-/- and Casp1-/- mice after renal I/R. Depletion of macrophages in vivo after I/R and a day before IL-1ß peak (at 7 days post-perfusion) totally prevented prolongation of QJ interval, suggesting that macrophages might participate as sensors of tissue injury. Moreover, treatment of I/R-WT mice with IL-1r antagonist (IL-1ra) from 8 to 15 days post perfusion did not interfere with renal function, but reversed QJ prolongation, prevented the increase in susceptibility to ventricular arrhythmias and rescued a close to normal duration and amplitude of calcium transient. CONCLUSION: Taken together, these results corroborate the hypothesis that IL-1ß is produced after sensing renal injury through NRLP3-CASP1, and IL-1ß on its turn triggers longer ventricular repolarization and increase susceptibility to cardiac arrhythmias. Still, they offer a therapeutic approach to treat cardiac arrhythmias that arise after renal I/R.

Dengue in Santander State, Colombia: fluctuations in the prevalence of virus serotypes are linked to dengue incidence and genetic diversity of the circulating viruses.

OBJECTIVE: To investigate the link between fluctuations in the prevalence of dengue virus (DENV) serotypes and the number of dengue cases in the metropolitan area of Bucaramanga, Santander State, Colombia, in the 2007-2010 and 2014-2017 periods. METHOD: Viruses were isolated from febrile patient samples by direct application to C6/36-HT cells and typed using monoclonal antibodies. We performed autocorrelation and cross-correlation analyses to determine whether fluctuations in the prevalence of DENV serotypes and dengue cases were correlated. Full envelope (E) gene sequences were employed to examine the genetic diversity of serotypes circulating by using a phylogenetic approach. RESULTS: All four dengue virus serotypes were detected. DENV-1 was the dominant serotype in both periods followed by DENV-3 or DENV-2 depending on the period; DENV-4 was the least prevalent virus in both periods. Cross-correlation analyses suggest a temporal relation between the fluctuations in the prevalence of DENV serotypes, which were almost simultaneous (lag = 0) or related to recent past fluctuations (lag > 1.0) in the number of dengue cases. Data suggest that a sustained predominance of DENV-1, an increase of the DENV-4 prevalence, and a switch from DENV-3 to DENV-2 could be linked to an outbreak. Circulating viruses were grouped into Genotype V, Asia/American III and II for DENV-1, -2, -3 and -4, respectively; intragenotypic diversity was detected. CONCLUSIONS: The present work highlights the need of comprehensive studies on dynamics of DENV in Colombia to understand transmission of dengue and evaluate the effectiveness of a vaccination programme.

OBJECTIF: Etudier le lien entre les fluctuations de la prévalence des sérotypes du virus de la dengue (DENV) et le nombre de cas de dengue dans la région métropolitaine de Bucaramanga, dans l'Etat de Santander, en Colombie, au cours des périodes 2007-2010 et 2014-2017. MÉTHODE: Les virus ont été isolés à partir d'échantillons de patients fébriles par application directe sur des cellules C6/36-HT et typés à l'aide d'anticorps monoclonaux. Nous avons effectué des analyses d'autocorrélation et de corrélation croisée afin de déterminer si les fluctuations de la prévalence des sérotypes du DENV et des cas de dengue étaient corrélées. Des séquences de gènes d'enveloppe complète (E) ont été utilisées pour examiner la diversité génétique des sérotypes en circulation en utilisant une approche phylogénétique. RÉSULTATS: Tous les quatre sérotypes du virus de la dengue ont été détectés. DENV-1 était le sérotype dominant dans les deux périodes, suivi de DENV-3 ou DENV-2, selon la période; le virus DENV-4 était le moins prévalent au cours des deux périodes. Les analyses de corrélation croisée suggèrent une relation temporelle entre les fluctuations de la prévalence des sérotypes de DENV, qui étaient presque simultanées (lag = 0) ou liées aux fluctuations passées récentes (lag > 1,0) du nombre de cas de dengue. Les données suggèrent qu'une prédominance durable de DENV-1, qu'une augmentation de la prévalence de DENV-4 et qu'un passage de DENV-3 à DENV-2 pourraient être liés à une éclosion. Les virus en circulation ont été regroupés dans les génotypes V, Asie/Amérique III et II pour DENV-1, -2, -3 et -4, respectivement; une diversité intra-génotypique a été détectée. CONCLUSIONS: Le présent travail souligne la nécessité d'études approfondies sur la dynamique du DENV en Colombie afin de comprendre la transmission de la dengue et évaluer l'efficacité d'un programme de vaccination.

The Reprimo Gene Family: A Novel Gene Lineage in Gastric Cancer with Tumor Suppressive Properties.

The reprimo (RPRM) gene family is a group of single exon genes present exclusively within the vertebrate lineage. Two out of three members of this family are present in humans: RPRM and RPRM-Like (RPRML). RPRM induces cell cycle arrest at G2/M in response to p53 expression. Loss-of-expression of RPRM is related to increased cell proliferation and growth in gastric cancer. This evidence suggests that RPRM has tumor suppressive properties. However, the molecular mechanisms and signaling partners by which RPRM exerts its functions remain unknown. Moreover, scarce studies have attempted to characterize RPRML, and its functionality is unclear. Herein, we highlight the role of the RPRM gene family in gastric carcinogenesis, as well as its potential applications in clinical settings. In addition, we summarize the current knowledge on the phylogeny and expression patterns of this family of genes in embryonic zebrafish and adult humans. Strikingly, in both species, RPRM is expressed primarily in the digestive tract, blood vessels and central nervous system, supporting the use of zebrafish for further functional characterization of RPRM. Finally, drawing on embryonic and adult expression patterns, we address the potential relevance of RPRM and RPRML in cancer. Active investigation or analytical research in the coming years should contribute to novel translational applications of this poorly understood gene family as potential biomarkers and development of novel cancer therapies.

Assessing the impact of conversational overlap in content on child language growth.

When engaged in conversation, both parents and children tend to re-use words that their partner has just said. This study explored whether proportions of maternal and/or child utterances that overlapped in content with what their partner had just said contributed to growth in mean length of utterance (MLU), developmental sentence score, and vocabulary diversity over time. We analyzed the New England longitudinal corpus from the CHILDES database, comprising transcripts of mother-child conversations at 14, 20, and 32 months, using the CHIP command to compute proportions of utterances with overlapping content. Rates of maternal overlap, but not child overlap, at earlier time-points predicted child language outcomes at later time-points, after controlling for earlier child MLU. We suggest that maternal overlap plays a formative role in child language development by providing content that is immediately relevant to what the child has in mind.

Canopy Architecture and Sun Exposure Influence Berry Cluster-Water Relations in the Grapevine Variety Muscat of Alexandria.

Climate-change-related increases in the frequency and intensity of heatwaves affect viticulture, leading to losses in yield and grape quality. We assessed whether canopy-architecture manipulation mitigates the effects of summer stress in a Mediterranean vineyard. The Vitis vinifera L variety Muscat of Alexandria plants were monitored during 2019-2020. Two canopy shoot-positioning treatments were applied: vertical shoot positioning (VSP) and modulated shoot positioning (MSP). In MSP, the west-side upper foliage was released to promote partial shoot leaning, shading the clusters. Clusters were sampled at pea size (PS), veraison (VER), and full maturation (FM). Measurements included rachis anatomy and hydraulic conductance (Kh) and aquaporins (AQP) and stress-related genes expression in cluster tissues. The results show significant seasonal and interannual differences in Kh and vascular anatomy. At VER, the Kh of the rachis and rachis+pedicel and the xylem diameter decreased but were unaffected by treatments. The phloem-xylem ratio was either increased (2019) or reduced (2020) in MSP compared to VSP. Most AQPs were down-regulated at FM in pedicels and up-regulated at VER in pulp. A potential maturation shift in MSP was observed and confirmed by the up-regulation of several stress-related genes in all tissues. The study pinpoints the role of canopy architecture in berry-water relations and stress response during ripening.

Procedural pain in patients with cancer: a Delphi expert management consensus.

OBJECTIVES: Diagnosis, treatment and care of cancer often involve procedures that may be distressing and potentially painful for patients. The PROCEDIO Study aimed to generate expert-based recommendations on the management of moderate to severe procedural pain in inpatients and outpatients with cancer. METHODS: Using a two-round Delphi method, experts from pain and palliative care units, medical and radiation oncology and haematology departments expressed their agreement on 24 statements using a 9-point Likert scale, which were classified as appropriate (median 7-9), uncertain (4-6) or inappropriate (1-3). Consensus was achieved if at least two-thirds of the panel scored within the range containing the median. RESULTS: With an overall agreement on the current definition of procedural pain, participants suggested a wider description based on evidence and their clinical experience. A strong consensus was achieved regarding the need for a comprehensive pre-procedural pain assessment and experts emphasised that healthcare professionals involved in procedural pain management should be adequately trained. Most panellists (98.2%) agreed that pharmacological treatment should be chosen considering the duration of the procedure. Transmucosal fentanyl (96.5%) and morphine (71.7%) were recommended as the most appropriate drugs. Oral and nasal transmucosal fentanyl were agreed as the most suitable for both outpatients and inpatients, while consensus was reached for intravenous and subcutaneous morphine for inpatients. CONCLUSIONS: These results provide updated expert-based recommendations on the definition, prevention and treatment of moderate to severe procedural pain, which could inform specialists involved in pain management of patients with cancer.

[Identification of occupational risks associated with diseases suspected to be of possible occupational origin seen in the National Health System]. / Identificación de los riesgos laborales asociados a enfermedad sospechosa de posible origen laboral atendida en el Sistema Nacional de Salud.

In an earlier study, we identified 26 diseases of possible occupational origin, seen in different settings within the national health system in Catalonia. In this literature review we identify those occupational risk factors most strongly associated with these pathologies. After applying inclusion/exclusion criteria to 754 reviews, meta-analyses and/or practice guidelines, 37 articles remained that were rated for study quality by 3 reviewers. Of these, the 31 studies of highest quality were examined in depth, and summarised in a final table. Ergonomic risk factors (manual handling of materials, highly repetitive movements and awkward postures), especially for musculoskeletal disorders of the upper extremity, and exposures to chemical products and physical agents, were prominent. These results provide an additional resource for primary care physicians to assist them with the identification of possible occupational illness and to improve communication between the National Health Service and social security system.

Vine Irrigation through Two Shoot Densities in Flavonoid and Non-Flavonoid Compounds in 'Tempranillo' Grapes.

This study aims to analyze the effects of non-limiting irrigation (I) vs. rainfed (R) through two different shoot densities, high-load (H) and low-load (L), on vegetative growth, agronomic parameters, flavonoid and non-flavonoid polyphenol substances of cv. Tempranillo grown in a semi-arid climate during three consecutive seasons (2014-2016). Under these conditions, in the 2015 and 2016 seasons, irrigation showed significant increases in berry weight (14.7% and 13.4% in H and L, respectively, in 2015, and 35.6% and 23.5% in the same treatments in 2016) and yield (66.7% and 48.5 in 2015; 27.9% and 177.5% in 2016). Additionally, a general decreasing trend is observed in anthocyanins with the exception of peonidin derivates, almost all flavonol compounds, cinnamic acid and resveratrol values with different degrees and statistical significance depending on the shoot density of the vines. A slight variation is observed in 2014 in these parameters. On the other hand, no general trends are established either in flavanol compounds or hydroxybenzoic acid. Thus, the effect of irrigation depends on the parameter considered, the shoot density of the vine and the season considered.

Postintensive care syndrome in COVID-19. Unicentric pilot study. Calm does not come after the storm.

Introduction: Postintensive care syndrome (PICS) is the physical, cognitive or psychiatric deterioration that appears after a critical illness and persists beyond hospital admission. The objective of this study was to describe the prevalence of PICS in the patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit of the Consorcio Hospital General Universitario de Valencia. Patients: They benefited from a standardized assessment, addressing health-related quality of life (EuroQol-5D-3L), a physical status (6 MWT, "test up and go" and hand dynamometer), a nutritional assessment (MUST and the Global Subjective Assessment), cognitive impairment (MoCA), mental health disorders (HADS and Davidson Trauma Scale) and pain (visual analogue scale and DN4). Results: From March to June 2020, 59 patients with SARS-CoV-2 were admitted to our ICU. 29 of these were recruited for the study. The stay in the ICU and the mechanical ventilation time were long (24 days [IQR 12-36], and 18 days [IQR 7-31] respectively). The SOFA upon admission to the ICU was high (3 [IQR 3-5]). Tracheostomy was performed in 52% and pronation in 93%. 90% had some abnormal test. 20% had post-traumatic stress syndrome. Conclusions: We found that 9 out of 10 survivors of SARS-CoV-2 admitted had at least one PICS alteration at 4-6 weeks from discharge from the Hospital. Six out of 19 patients presented with two or more affected evaluated areas.

Antecedentes y objetivo: El síndrome post cuidados intensivos (SPCI) es el deterioro físico, cognitivo o psiquiátrico que aparece después de una enfermedad crítica y persiste tras el ingreso hospitalario. El objetivo es evaluar la prevalencia de SPCI en los pacientes con enfermedad por coronavirus 2019 (COVID-19) ingresados en la unidad de cuidados críticos (UCI) del Consorcio Hospital General Universitario de Valencia. Pacientes: Se evaluó la calidad de vida subjetiva (EuroQol-5D-3L), el estado funcional (test de marcha de 6 min, «levanta y anda¼ y dinamómetro de mano); nutricional (Malnutrition Universal Screening Tool [MUST] y Valoración subjetiva global [VSG]); montreal cognitive assessment (MoCA); mental (escala de ansiedad y depresión hospitalaria [HADS] y escala de Trauma de Davidson) y de dolor (escala visual analógica y detección de dolor neuropático-DN4). Resultados: Del 1 de marzo al 30 de junio del 2020 ingresaron en UCI 59 pacientes por SARS-CoV-2. Contactamos con los 29 supervivientes a las cuatro a seis semanas del alta hospitalaria. La estancia en UCI (24 días [IQR 12−36]) y el tiempo de ventilación mecánica (18 días [IQR 7−31]) fueron prolongados. El Sequential Organ Failure Assessment (SOFA) al ingreso en UCI fue elevado (3 [IQR 3−5]). Se realizó traqueostomía en el 52% y pronación al 93%. En cuanto al SPCI, el 90% tenía algún test alterado. Presentaron dos o más test alterados seis de cada 10. Un 20% presentó el test para detección del trastorno de estrés postraumático (TEPT) patológico. Conclusiones: Encontramos que nueve de cada 10 supervivientes de una neumonía por SARS-CoV-2 ingresados en UCI tenían al menos una alteración de SPCI a las cuatro a seis semanas del alta hospitalaria. Los problemas de SPCI concurrentes (dos o más) estuvieron presentes en más de seis de cada 10. Seis de los pacientes presentaron TEPT.

Postintensive care syndrome in COVID-19. Unicentric pilot study. / Síndrome post cuidados intensivos en COVID-19. Estudio piloto unicéntrico.

INTRODUCTION: Postintensive care syndrome (PICS) is the physical, cognitive or psychiatric deterioration that appears after a critical illness and persists beyond hospital admission. The objective of this study was to describe the prevalence of PICS in the patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit of the Consorcio Hospital General Universitario de Valencia. PATIENTS: They benefited from a standardized assessment, addressing health-related quality of life (EuroQol-5D-3L), a physical status (6 MWT, «test up and go¼ and hand dynamometer), a nutritional assessment (MUST and the Global Subjective Assessment), cognitive impairment (MoCA), mental health disorders (HADS and Davidson Trauma Scale) and pain (visual analogue scale and DN4). RESULTS: From March to June 2020, 59 patients with SARS-CoV-2 were admitted to our ICU. 29 of these were recruited for the study. The stay in the ICU and the mechanical ventilation time were long (24 days [IQR 12-36], and 18 days [IQR 7-31] respectively). The SOFA upon admission to the ICU was high (3 [IQR 3-5]). Tracheostomy was performed in 52% and pronation in 93%. 90% had some abnormal test. 20% had post-traumatic stress syndrome. CONCLUSIONS: We found that 9 out of 10 survivors of SARS-CoV-2 admitted had at least one PICS alteration at 4-6 weeks from discharge from the Hospital. Six out of 19 patients presented with two or more affected evaluated areas.

A few-shot approach for COVID-19 screening in standard and portable chest X-ray images.

Reliable and effective diagnostic systems are of vital importance for COVID-19, specifically for triage and screening procedures. In this work, a fully automatic diagnostic system based on chest X-ray images (CXR) has been proposed. It relies on the few-shot paradigm, which allows to work with small databases. Furthermore, three components have been added to improve the diagnosis performance: (1) a region proposal network which makes the system focus on the lungs; (2) a novel cost function which adds expert knowledge by giving specific penalties to each misdiagnosis; and (3) an ensembling procedure integrating multiple image comparisons to produce more reliable diagnoses. Moreover, the COVID-SC dataset has been introduced, comprising almost 1100 AnteroPosterior CXR images, namely 439 negative and 653 positive according to the RT-PCR test. Expert radiologists divided the negative images into three categories (normal lungs, COVID-related diseases, and other diseases) and the positive images into four severity levels. This entails the most complete COVID-19 dataset in terms of patient diversity. The proposed system has been compared with state-of-the-art methods in the COVIDGR-1.0 public database, achieving the highest accuracy (81.13% ± 2.76%) and the most robust results. An ablation study proved that each system component contributes to improve the overall performance. The procedure has also been validated on the COVID-SC dataset under different scenarios, with accuracies ranging from 70.81 to 87.40%. In conclusion, our proposal provides a good accuracy appropriate for the early detection of COVID-19.

The safety of magnetic resonance imaging in patients with programmable implanted intrathecal drug delivery systems: a 3-year prospective study.

BACKGROUND: It is common clinical practice to perform magnetic resonance imaging (MRI) in patients with indwelling programmable intrathecal drug delivery (IDD) systems, although the safety of the procedure has never been documented. We performed a single-center, 3-year, prospective evaluation in patients with a programmable implanted IDD to assess patient discomfort, IDD technical failures, and adverse effects during and after exposure to MRI. METHODS: Forty-three consecutive patients with an implanted programmable IDD system (SynchroMed® EL Implantable Infusion Pump, Model 8626L-18, and SynchroMed® II Model 8637-20, 8637-40; Medtronic, Inc., Minneapolis, MN) requiring a scheduled MRI evaluation were studied during a 3-year period. All MRI scans were performed with a 1.5-tesla clinical use magnet and a specific absorption rate of no more than 0.9 W/kg. Radiograph control was used to confirm postexposure pump rotor movement and detect system dislocations. IDD system failures, patient satisfaction, and discomfort were recorded. RESULTS: None of the patients experienced signs of drug overinfusion that could lead to hemodynamic, respiratory, or neurologic alterations. Radiologic evaluation after MRI revealed no spatial displacements of the intrathecal catheter tip or body pump, and programmer telemetry confirmed the infusion recovery. Patients' satisfaction after the procedure was high. CONCLUSION: Performing an MRI scan with the proposed protocol in patients with an implanted Medtronic programmable IDD system resulted in virtually no technical or medical complications.

NOD Mice Recapitulate the Cardiac Disturbances Observed in Type 1 Diabetes.

This work aimed at testing the hypothesis that NOD/ShiLtJ mice (NOD) recapitulate the cardiac disturbances observed on type 1 diabetes (T1D). NOD mice were studied 4 weeks after the onset of hyperglycemia, and NOR/Lt mice matched as control. Cardiac function was evaluated by echocardiography and electrocardiography (ECG). Action potentials (AP) and Ca2+ transients were evaluated at whole heart level. Heart mitochondrial function was evaluated by high-resolution respirometry and H2O2 release. NOD mice presented a reduction in hearth weight. Mitochondrial oxygen fluxes and H2O2 release were similar between NOD and NOR mice. ECG revealed a QJ interval prolongation in NOD mice. Furthermore, AP duration at 30% of repolarization was increased, and it depicted slower Ca2+ transient kinetics. NOD mice presented greater number/severity of ventricular arrhythmias both in vivo and in vitro. In conclusion, NOD mice evoked cardiac electrical and calcium handling disturbances similar to the observed in T1D. Graphical Abstract .

Identification of CRF89_BF, a new member of an HIV-1 circulating BF intersubtype recombinant form family widely spread in South America.

Circulating recombinant forms (CRFs) contribute substantially to the HIV-1 pandemic. Among 105 CRFs described in the literature, 16 are BF intersubtype recombinants, most of South American origin, of which CRF12_BF is the most widely spread. A BF recombinant cluster identified in Bolivia was suggested to represent a new CRF_BF. Here we find that it belongs to a larger cluster incorporating 39 viruses collected in 7 countries from 3 continents, 22 of them in Spain, most from Bolivian or Peruvian individuals, and 12 in South America (Bolivia, Argentina, and Peru). This BF cluster comprises three major subclusters, two associated with Bolivian and one with Peruvian individuals. Near full-length genome sequence analyses of nine viruses, collected in Spain, Bolivia, and Peru, revealed coincident BF mosaic structures, with 13 breakpoints, 6 and 7 of which coincided with CRF12_BF and CRF17_BF, respectively. In a phylogenetic tree, they grouped in a clade closely related to these CRFs, and more distantly to CRF38_BF and CRF44_BF, all circulating in South America. These results allowed to identify a new HIV-1 CRF, designated CRF89_BF. Through phylodynamic analyses, CRF89_BF emergence was estimated in Bolivia around 1986. CRF89_BF is the fifth CRF member of the HIV-1 recombinant family related to CRF12_BF.

Ecohydrogeochemical functioning of coastal freshwater herbaceous wetlands in the Protected Natural Area, Ciénaga del Fuerte (American tropics): Spatiotemporal behaviour.

Coastal zones are characterized by the interactions between continents and oceans and, therefore, between fresh and salt surface and groundwater. The wetlands of coastal zones represent transitional ecosystems that are affected by these conditions, although little is known about the hydrogeochemistry of wetlands, especially coastal wetlands. In the present study, the hydrogeochemical characterization of coastal freshwater herbaceous wetlands in the Ciénaga del Fuerte Protected Natural Area in Veracruz, Mexico, in the American tropics was carried out per plant community. Four herbaceous wetlands (alligator flag, saw grass, cattail, and floodplain pasture) were monitored to understand the origin of the water feeding these ecosystems, the hydrogeochemical composition of groundwater, and the relationship between the groundwater and ecology of these ecosystems during dry and rainy seasons. The results indicate that Ciénaga del Fuerte is located in a regional discharge area and receives local recharge, so it is fed by both regional and local flows. The chemical composition varied temporally and spatially, creating unique conditions that determined the habitat occupied by the hydrophytic vegetation. The spatiotemporal behaviour of groundwater is one factor that, along with the hydroperiod, determines wetland dynamics and affects wetland biota (ecohydrogeochemistry). Generalist plant communities established in zones of local recharge, whereas other more specialized and/or plastic communities inhabited zones receiving regional flows with greater ion concentrations. This information forms the basis for establishing an appropriate scale (municipal, state, or larger regions) for the sustainable management of goods and services provided by the wetlands.

Breakthrough cancer pain treatment in Spain: physicians' perception of current opioids utilization and prescription.

Objectives: Multiple reasons for suboptimal treatment of breakthrough cancer pain (BTcP) have been reported in the literature. We aimed to ascertain the perception of physicians on the potential inappropriate use and prescription of rapid-onset opioids (ROOs) for breakthrough cancer pain (BTcP) and the causes thereof.Methods: Observational study based on an online survey addressed to doctors from different specialties (radiation oncology, medical oncology, anesthesia, palliative care and general practitioners) with experience in the management of BTcP in the Spanish public health setting.Results: A total of 114 eligible specialists mainly from radiation oncology (37.7%), medical oncology (24.6%) and pain units (18.4%) participated in the study. Most agreed on important aspects of BTcP management, such as their preference for ROOs or the need for early follow-up after treatment initiation. However, their answers revealed a lack of standardization of BTcP diagnosis. Half of respondents believed that their BTcP patients might misuse ROOs. Physicians polled believed that lack of training in pain management (71.9%) and inadequate BTcP diagnosis and evaluation (66.7%) were the greatest obstacles for prescribing opioids. Specialists also thought that they do not provide the necessary information to patients (51.8%) and caregivers (57.9%) to guarantee the correct use of these drugs.Conclusions: These results are of utmost importance as they highlight the need to increase physicians' awareness of BTcP and its management and the need to improve communication with patients and their caregivers. Our findings also indicate the need for future research on the possible misuse of opioids in BTcP patients and its causes.

Current Situation of the Presence of Dirofilaria immitis in Dogs and Humans in Bucaramanga, Colombia.

The cardiopulmonary dirofilariosis caused by Dirofilaria immitis, is a vector-borne infection, which can be transmitted to humans. The main hosts are both domestic and wild canids. This species mainly occurs in tropical and subtropical climates, and temperature and humidity are the main factors that favor the presence and proliferation of culicid mosquitoes as vectors of the disease. There are few reports of cardiopulmonary dirofilariosis in dogs and humans in Colombia, a region with favorable climatic conditions which favors the presence of mosquitoes that act as vectors of the disease. Therefore, this study aimed to examine its current prevalence in dogs and the risk of human exposure to the disease in Bucaramanga, one of the most populated areas in Colombia located at the center of the country. Furthermore, its demographic and environmental characteristics could be useful as a study model for other similar locations and neighboring countries. Serum samples from 351 dogs and 506 humans from the Bucaramanga Metropolitan area were analyzed. All dog samples were analyzed by Knott's technique and tested with a commercial immunochromatographic to detect the presence of circulating antigens of D. immitis. Human samples were analyzed using a non-commercial ELISA test kit to detect IgG against the somatic antigens of adult D. immitis and Wolbachia. Positive results were further confirmed using western blot analysis. Thirty-eight dogs tested positive with a overall prevalence of 10.82%. Of these dogs, 18 showed D. immitis microfilariae, being 5.12% of the total population. The overall seroprevalence in humans was 6.71%; seroprevalence was significantly higher in individuals aged 16-34 years-old and in women than in men. To our knowledge, this study describes seropositivity to D. immitis for the first time in a Colombian human population located in the same area as that of dogs infected with D. immitis, which represents a potential threat to public health. In humans, age and gender can be considered risk factors for exposure to D. immitis.