Factors Associated with Worsening Interstitial Fibrosis/Tubular Atrophy in Lupus Nephritis Patients Undergoing Repeat Kidney Biopsy.

Background: Lupus nephritis (LN) is one of the most severe manifestations of systemic lupus erythematosus (SLE). Interstitial fibrosis/tubular atrophy (IFTA) on kidney biopsies strongly predicts progression to end-stage renal disease. However, factors associated with progression of IFTA are not known. The objective of this study was to evaluate the demographic, clinical, and histopathological factors at the time of index kidney biopsies that are associated with worsening IFTA on repeat biopsies. Methods: Patients with LN Class I to V or mixed LN on index biopsies who underwent a clinically indicated repeat biopsy between 2004 and 2020 were identified. None-mild IFTA was defined as < 25% acreage of the interstitium affected by fibrosis and atrophy, and moderate-severe IFTA was defined as ≥ 25% of the interstitium affected. Patients with none-mild IFTA on index biopsies who progressed to moderate-severe IFTA on repeat biopsies were defined as progressors. Patients with none-mild IFTA on both biopsies were defined as non-progressors. Results: Seventy-two patients who underwent clinically indicated repeat kidney biopsies were included, and 35 (49%) were identified as progressors. Compared to non-progressors, progressors had a higher proportion of proliferative LN (20 [57%] vs. 6 [17%], p = 0.002) and crescents (9 [26%] vs. 3 [8%], p = 0.045) on index biopsies. There was no difference regarding the time to repeat biopsy or the baseline characteristics, including eGFR, presence of hypertension and diabetes, urine protein to creatinine ratio, or the initial treatments. Conclusions: Proliferative LN and the presence of crescents on index biopsies were associated with subsequent IFTA progression on repeat biopsies. This association indicates that glomerular damage is one of the major drivers of tubulointerstitial scarring in SLE. IFTA progression may, in turn, be the driving factor of poor treatment response and progression to chronic kidney disease.

Association of Hydroxychloroquine Dose With Adverse Cardiac Events in Patients With Systemic Lupus Erythematosus.

OBJECTIVE: To determine whether hydroxychloroquine (HCQ) dose is associated with adverse cardiac outcomes in patients with systemic lupus erythematosus (SLE). METHODS: Patients with SLE taking HCQ and with ≥1 echocardiogram followed at a tertiary care center in the Bronx, New York between 2005 and 2021 were included. The HCQ weight-based dose at the HCQ start date was the main exposure of interest. The outcome was incident all-cause heart failure with reduced ejection fraction (HFrEF), life-threatening arrhythmia, or cardiac death. We used Fine-Gray regression models with death as a competing event to study the association of HCQ dose with the outcome. Due to a significant interaction between smoking and HCQ exposure, models were stratified by smoking status. Propensity score analysis was performed as a secondary analysis. RESULTS: Of 294 patients, 37 (13%) developed the outcome over a median follow-up time of 7.9 years (interquartile range [IQR] 4.2-12.3 years). In nonsmokers (n = 226), multivariable analysis adjusted for age, body mass index, hypertension, chronic kidney disease, diabetes mellitus, and thromboembolism showed that higher HCQ weight-based doses were not associated with an increased risk of the outcome (subdistribution hazard ratio [HR] 0.62 [IQR 0.41-0.92], P = 0.02). Similarly, higher baseline HCQ doses were not associated with a higher risk of the outcome among smokers (n = 68) (subdistribution HR 0.85 [IQR 0.53-1.34] per mg/kg, P = 0.48). Propensity score analysis showed comparable results. CONCLUSION: Higher HCQ doses were not associated with an increased risk of HFrEF, life-threatening arrhythmia, or cardiac death among patients with SLE and may decrease the risk among nonsmokers.

Membrane attack complex (MAC) deposition in renal tubules is associated with interstitial fibrosis and tubular atrophy: a pilot study.

INTRODUCTION: Treatment failures for lupus nephritis (LN) are high with 10%-30% of patients progressing to end-stage renal disease (ESRD) within 10 years. Interstitial fibrosis/tubular atrophy (IFTA) is a predictor of progression to ESRD. Prior studies suggest that tubulointerstitial injury secondary to proteinuria in LN is mediated by complement activation in the tubules, specifically through the membrane attack complex (MAC). This study aimed to investigate the associations between tubular MAC deposition with IFTA and proteinuria. METHODS: In this cross-sectional study, LN kidney biopsies were assessed for MAC deposition by staining for Complement C9, a component of the MAC. Chromogenic immunohistochemistry was performed on paraffin-embedded human renal biopsy sections using unconjugated, murine anti-human Complement C9 (Hycult Biotech, clone X197). Tubular C9 staining intensity was analysed as present versus absent. IFTA was defined as minimal (<10%), mild (10%-24%), moderate (25%-50%) and severe (>50%). RESULTS: Renal biopsies from 30 patients with LN were studied. There were 24 (80%) female sex, mean age (SD) was 33 (12) years old and 23 (77%) had pure/mixed proliferative LN. Tubular C9 staining was present in 7 (23%) biopsies. 27 patients had minimal-to-mild IFTA and 3 patients had moderate IFTA. Among the C9 + patients, 3 (43%) had moderate IFTA as compared with none in the C9- group, p=0.009. C9 + patients had higher median (IQR) proteinuria as compared with C9- patients: 6.2 g (3.3-13.1) vs 2.4 g (1.3-4.6), p=0.001 at the time of biopsy. There was no difference in estimated glomerular filtration rate (eGFR) between the C9 + and C9- groups. CONCLUSION: This study demonstrated that tubular MAC deposition is associated with higher degree of IFTA and proteinuria, which are predictors of progression to ESRD. These results suggest that tubular MAC deposition may be useful in classification of LN. Understanding the role of complement in tubulointerstitial injury will also identify new avenues for LN treatment.

Clinical validation of risk scoring systems to predict risk of delayed bleeding after EMR of large colorectal lesions.

BACKGROUND AND AIMS: The Endoscopic Resection Group of the Spanish Society of Endoscopy (GSEED-RE) model and the Australian Colonic Endoscopic Resection (ACER) model were proposed to predict delayed bleeding (DB) after EMR of large superficial colorectal lesions, but neither has been validated. We validated and updated these models. METHODS: A multicenter cohort study was performed in patients with nonpedunculated lesions ≥20 mm removed by EMR. We assessed the discrimination and calibration of the GSEED-RE and ACER models. Difficulty performing EMR was subjectively categorized as low, medium, or high. We created a new model, including factors associated with DB in 3 cohort studies. RESULTS: DB occurred in 45 of 1034 EMRs (4.5%); it was associated with proximal location (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.31-6.16), antiplatelet agents (OR, 2.51; 95% CI, .99-6.34) or anticoagulants (OR, 4.54; 95% CI, 2.14-9.63), difficulty of EMR (OR, 3.23; 95% CI, 1.41-7.40), and comorbidity (OR, 2.11; 95% CI, .99-4.47). The GSEED-RE and ACER models did not accurately predict DB. Re-estimation and recalibration yielded acceptable results (GSEED-RE area under the curve [AUC], .64 [95% CI, .54-.74]; ACER AUC, .65 [95% CI, .57-.73]). We used lesion size, proximal location, comorbidity, and antiplatelet or anticoagulant therapy to generate a new model, the GSEED-RE2, which achieved higher AUC values (.69-.73; 95% CI, .59-.80) and exhibited lower susceptibility to changes among datasets. CONCLUSIONS: The updated GSEED-RE and ACER models achieved acceptable prediction levels of DB. The GSEED-RE2 model may achieve better prediction results and could be used to guide the management of patients after validation by other external groups. (Clinical trial registration number: NCT03050333.).

Postural adjustments of active youths in perturbation and dual-task conditions / Ajustes posturais de jovens ativos em condições de perturbação e tarefa dupla / Ajustes posturales de jóvenes activos en condiciones de perturbación y doble tarea

ABSTRACT Introduction Cognitive components are necessary to maintain posture during external perturbations. However, few studies have investigated postural control when external perturbations are associated with a concomitant cognitive task (DT). Objectives To analyze the behavior of reactive adjustments after perturbation with different intensities and displacements in active young adults; and to analyze the influence of DT on predictive and reactive adjustments in different perturbation conditions. Methods Twenty-eight physically active young adults stood on an item of equipment that produced displacements of the base. Four experimental conditions were introduced in a single task (ST) and DT (cognitive-report how many times a pre-established number appeared in the audio): 1 (5 cm and 10 cm/s); 2 (5 cm and 25 cm/s); 3 (12 cm and 10 cm/s) and 4 (12 cm and 25 cm/s). Three attempts were carried out for each condition (total=24). Center of pressure (CoP) parameters were analyzed considering the following windows: predictive (-250 to +50 ms), reactive 1 (+50 to +200 ms) and reactive 2 (+200 to +700 ms), in comparison to the start of the CoP activity. One-way ANOVAs were performed to analyze predictive adjustments, while two-way ANOVAs with factor for task (STxDT) and condition (1x2x3x4), with repeated measurements, were performed for the reactive adjustments. Results One-way ANOVA (predictive) indicated that the subjects had higher CoP parameters in ST vs DT. In reactive adjustments 1 and 2, ANOVA indicated greater CoP parameters in condition 2 and 4 when compared to 1 and 3, and in the ST vs DT. The subjects took longer to recover stable position in conditions 1 and 3 than in conditions 2 and 4. Conclusion Perturbation intensity has a greater influence on postural adjustments to maintain balance than on magnitude. Moreover, the association of cognitive tasks with external perturbation decreases CoP oscillation. Therefore, cognitive resources play an important role in postural control after perturbation. Level of evidence III; Study of nonconsecutive patients, with no "gold" standard applied uniformly.

RESUMO Introdução Componentes cognitivos são necessários para manter a postura nas perturbações externas. Porém, poucos estudos investigaram o controle postural quando perturbações externas são associadas à tarefa cognitiva concomitante (TD). Objetivo Analisar o comportamento dos ajustes reativos após perturbação com diferentes intensidades e deslocamentos em adultos jovens ativos; e analisar a influência da TD nos ajustes preditivos e reativos em diferentes condições de perturbação. Métodos Permaneceram em pé sobre um equipamento que provocou deslocamento da base de suporte 28 adultos jovens fisicamente ativos. Quatro condições experimentais foram realizadas em tarefa simples (TS) e TD (cognitiva-reportar quantas vezes um número preestabelecido apareceu no áudio): uma (5cm e 10cm/s); duas (5cm e 25cm/s); três (12cm e 10cm/s) e quatro (12cm e 25cm/s). Foram realizadas três tentativas para cada condição (total=24). Os parâmetros do centro de pressão (CoP) foram analisados em janelamentos: preditivo (-250 a +50ms), reativo 1 (+50 a +200ms) e reativo 2 (+200 a +700ms), em relação ao início da atividade do CoP. ANOVAs one-way foram realizadas para análise dos ajustes preditivos. Já para os ajustes reativos, foram realizadas ANOVAs two-way com fator para tarefa (TS×TD) e condição (1×2×3×4) com medidas repetidas. Resultados ANOVA one-way (preditivo) apontou que os indivíduos apresentaram maiores parâmetros do CoP na TS em relação à TD. Nos reativos 1 e 2, a ANOVA apontou maiores parâmetros do CoP na segunda e na quarta condição quando comparada à primeira e à terceira, e na TS em relação às TD. Apresentaram maior tempo para recuperar a posição estável na primeira e na terceira condição em comparação à segunda e à quarta. Conclusão A intensidade da perturbação influencia mais nos ajustes posturais para manutenção do equilíbrio do que a magnitude. Ainda, as tarefas cognitivas concomitantes à perturbação externa diminuem a oscilação do CoP. Com isso, recursos cognitivos possuem relevância no controle postural após perturbação. Nível de evidência III; Estudos de pacientes não consecutivos, sem padrão de referência "ouro" aplicado uniformemente.

RESUMEN Introducción Los componentes cognitivos son necesarios para mantener la postura en perturbaciones externas. Sin embargo, pocos estudios investigaron el control postural cuando son asociadas perturbaciones a la tarea cognitiva concomitante (TD). Objetivo Analizar el comportamiento de los ajustes reactivos después de una perturbación con diferentes intensidades y desplazamientos en adultos jóvenes activos; y analizar la influencia de la TD en ajustes predictivos y reactivos en diferentes condiciones de perturbación. Métodos Veintiocho adultos jóvenes físicamente activos permanecieron en pie sobre un equipo que provocó desplazamiento de la base de soporte. Cuatro condiciones experimentales fueron realizadas en tareas simples (TS) y TD (cognitiva-reportar cuántas veces un número preestablecido apareció en el audio): una (5 cm y 10 cm/s); dos (5 cm y 25 cm/s); tres (12 cm y 10 cm/s) y cuatro (12 cm y 25 cm/s). Fueron realizadas tres tentativas para cada condición (total=24). Los parámetros del centro de presión (CoP) fueron analizados en ventanas: predictiva (-250 a +50 ms), reactiva 1 (+50 a +200 ms) y reactiva 2 (+200 a +700 ms) en relación al inicio de la actividad del CoP. Fueron realizadas ANOVAs one-way para análisis de los ajustes predictivos. Fueron realizadas ANOVAs two-way con factor para tarea (TSxTD) y condición (1x2x3x4) con medidas repetidas para análisis de los ajustes reactivos. Resultados ANOVA one-way (predictivo) mostró que los individuos presentaron parámetros mayores de CoP en TS con relación a TD. En los reactivos 1 y 2, ANOVA mostró parámetros del CoP en la segunda y cuarta condición cuando comparada a la primera y la tercera, y en la TS con relación a las TD. Presentaron tiempo mayor para recuperar la posición estable en la primera y tercera condición en comparación a la segunda y la cuarta. Conclusión La intensidad de perturbación influencia más en los ajustes posturales para mantenimiento del equilibrio que la magnitud. Además, las tareas cognitivas concomitantes a la perturbación externa disminuyen la oscilación del CoP. Con eso, los recursos cognitivos poseen relevancia en el control postural después de la perturbación. Nivel de evidencia III; Estudios de pacientes no consecutivos, sin estándar de referencia "oro" aplicado uniformemente.

Effects of linear and undulating periodization of strength training in the acceleration of skater children

Aim: This study aimed to compare the effects of linear periodization (LP) and undulating periodization (UP) of strength training on acceleration in skater children. Methods: Twenty-nine girls (9.67±1.29 years-old, 34.47±8.06kg, 1.39±0.13m) were distributed into two groups: linear periodization group (LPG, n=14) and undulating periodization group (UPG, n=15). Six levels of progressive training were designed based on activities such as multi-jumps, plyometrics, sled towing, and facilitated exercises. The training lasted 16 weeks, with a 1-h session on three non-consecutive days per week. The acceleration was recorded by digital videography following the major trochanter of the femur, at four moments and under two conditions: static (SS) and dynamic start (DS) in a rectilinear path. Statistical significance was set at 5%. Results: ANOVA indicated group*moment interaction in SS and DS for velocity (F3,81=7.883; p<0.001; pη2=0.226; F3,81=2.36; p=0.078; pη2=0.08-trend, respectively) and acceleration (F3,81=3.96; p=0.011; pη2=0.128; F3,81=2.92; p=0.039; pη2=0.098, respectively). Both groups increased velocity in SS and DS (UPG/SS: 1st=4.07, 2nd=9.75, 3rd=8.91, 4th=9.25m/s; LPG/SS: 1st=4.27, 2nd=7.13, 3rd=7.61, 4th=7.99m/s; UPG/DS: 1st=8.30, 2nd=8.73, 3rd=8.12, 4th=9.27m/s; LPG/DS: 1st=8.20, 2nd=8.31, 3rd=7.90, 4th=8.96m/s) and acceleration (UPG/SS: 1st=2.00, 2nd=8.69, 3rd=4.71, 4th=5.02m/s2; LPG/SS: 1st=2.37, 2nd=3.39, 3rd=3.68, 4th=4.12m/s2; UPG/DS: 1st=1.78, 2nd=1.97, 3rd=1.65, 4th=2.46m/s2; LPG/DS: 1st=1.67, 2nd=1.70, 3rd=1.48, 4th=1.93m/s2). Conclusion: Both strength training periodization protocols were effective in developing acceleration and velocity in girl skaters over 16 weeks; however, UP was more efficient than LP for improving acceleration.(AU)

Consenso chileno de técnicas de kinesiología respiratoria en pediatría / Chilean consensus about pediatric chest physioterapy

Chest physiotherapy is currently an outstanding therapeutic tool for the management of pediatric respiratory patients. Many and varied techniques, manual and assisted, have been developed, some requiring patient collaboration. The development of knowledge and the pathophysiological understanding of respiratory diseases in recent years has generated the need to agree on the terminology, the fundamentals and the application of each of the kinesthetic techniques of respiratory treatment in the pediatric field. The objective of this document was to compile the available literature related to the physiological mechanisms, indications, procedural aspects and most frequently used techniques in our country, with the purpose of being a guideline for the clinical practice of professionals and students. The following techniques were included: prolonged slow expiration, slow expiration with glottis opened, autogenic drainage, assisted autogenic drainage, active cycle, compression/decompression, airway clearance, forced expiration techniques, cough and respiratory exercises.

La kinesiología respiratoria es actualmente una herramienta terapéutica destacada para el manejo de los pacientes respiratorios pediátricos. Se han desarrollado muchas y variadas técnicas, manuales y asistidas, algunas requiriendo colaboración del paciente. El desarrollo del conocimiento y la comprensión fisiopatológica de las enfermedades respiratorias en los últimos años ha generado la necesidad de consensuar la terminología, los fundamentos y la aplicación de cada una de las técnicas kinésicas de tratamiento respiratorio en el ámbito pediátrico. El objetivo de este documento fue recopilar la literatura disponible relacionada con los mecanismos fisiológicos, indicaciones, aspectos procedimentales y técnicas más utilizadas en nuestro país, con el propósito de ser una directriz que oriente la práctica clínica de profesionales y estudiantes en formación. Se incluyeron así las siguientes técnicas: espiración lenta prolongada, espiración lenta con glotis abierta, drenaje autógeno, drenaje autógeno asistido, ciclo activo, presión/descompresión, bloqueos torácicos, técnicas de espiración forzada, tos y ejercicios respiratorios.

Oncogenic hijacking of the stress response machinery in T cell acute lymphoblastic leukemia.

Cellular transformation is accompanied by extensive rewiring of many biological processes leading to augmented levels of distinct types of cellular stress, including proteotoxic stress. Cancer cells critically depend on stress-relief pathways for their survival. However, the mechanisms underlying the transcriptional initiation and maintenance of the oncogenic stress response remain elusive. Here, we show that the expression of heat shock transcription factor 1 (HSF1) and the downstream mediators of the heat shock response is transcriptionally upregulated in T cell acute lymphoblastic leukemia (T-ALL). Hsf1 ablation suppresses the growth of human T-ALL and eradicates leukemia in mouse models of T-ALL, while sparing normal hematopoiesis. HSF1 drives a compact transcriptional program and among the direct HSF1 targets, specific chaperones and co-chaperones mediate its critical role in T-ALL. Notably, we demonstrate that the central T-ALL oncogene NOTCH1 hijacks the cellular stress response machinery by inducing the expression of HSF1 and its downstream effectors. The NOTCH1 signaling status controls the levels of chaperone/co-chaperone complexes and predicts the response of T-ALL patient samples to HSP90 inhibition. Our data demonstrate an integral crosstalk between mediators of oncogene and non-oncogene addiction and reveal critical nodes of the heat shock response pathway that can be targeted therapeutically.

Brief Report: Tubulointerstitial Damage in Lupus Nephritis: A Comparison of the Factors Associated With Tubulointerstitial Inflammation and Renal Scarring.

OBJECTIVE: To characterize and compare the factors associated with tubulointerstitial inflammation (TII) and tubulointerstitial scarring, defined as interstitial fibrosis and/or tubular atrophy (IF/TA), in patients with lupus nephritis (LN). METHODS: We identified systemic lupus erythematosus patients who had renal biopsy results consistent with LN between 2005 and 2017. Clinical data were collected from medical records. Multivariable logistic regression models were fitted to assess factors associated with TII and with IF/TA (moderate-to-severe versus none/mild). RESULTS: Of 203 LN patients included, 41 (20%) had moderate-to-severe TII, 45 (22%) had moderate-to-severe IF/TA, and 21 (10%) had both. Multivariable logistic regression models showed that moderate-to-severe TII was associated with a shorter disease duration, African American race, proliferative LN, and an estimated glomerular filtration rate (eGFR) of <60 ml/minute/1.73 m2 at the time of biopsy. Hydroxychloroquine use was associated with significantly lower odds of moderate-to-severe TII (odds ratio 0.27 [95% confidence interval 0.10-0.70], P = 0.008). Similar to TII, factors associated with moderate-to-severe IF/TA included proliferative LN and eGFR <60 ml/minute/1.73 m2 at the time of biopsy. In addition, the presence of moderate-to-severe TII and older age was associated with moderate-to-severe IF/TA. None of the routinely available serologic markers-including anti-double-stranded DNA antibodies, anti-Ro/La antibodies, and low complement-were associated with tubulointerstitial damage. CONCLUSION: The use of hydroxychloroquine was strongly associated with less inflammation, while the presence of TII, proliferative LN, and low eGFR were major determinants of tubulointerstitial scarring. Identifying modifiable factors is critical for the development of better preventive and therapeutic strategies with the goal of improving survival in patients with lupus-related kidney disease.

Tubulointerstitial damage predicts end stage renal disease in lupus nephritis with preserved to moderately impaired renal function: A retrospective cohort study.

OBJECTIVES: The presence of tubulointerstitial damage (TID) on renal biopsy is considered to be a late sequela of lupus nephritis (LN). The objective of this study was to determine if TID predicts progression to end stage renal disease (ESRD) in LN patients without advanced kidney disease. METHODS: All SLE patients with an index biopsy consistent with LN between January 2005 and July 2015, and eGFR ≥ 30mL/min/1.73m2 were included. Moderate-to-severe TID was defined as the presence of moderate-to-severe tubular atrophy and/or interstitial fibrosis. Time to ESRD was defined as time from the index biopsy date to incident ESRD date; non-ESRD patients were censored at the time of death or the last visit before December 2015. Time-dependent analyses were conducted to evaluate whether moderate-to-severe TID was predictive of ESRD progression. RESULTS: Of the 131 LN patients with eGFR ≥ 30mL/min/1.73m2, 17 (13%) patients progressed to ESRD. Moderate-to-severe TID was present in 13% of biopsies with eGFR ≥ 60mL/min/1.73m2 and in 33% of biopsies with eGFR between 30 and 60mL/min/1.73m2. Moderate-to-severe TID was associated with a higher risk of ESRD progression: adjusted hazard ratio (HR) = 4.1, 95% CI: 1.4-12.1, p = 0.01 for eGFR ≥ 30mL/min/1.73m2; HR = 6.2, 95% CI: 1.7-23.2, p = 0.008 for eGFR ≥ 60mL/min/1.73m2. There was no association between tubulointerstitial inflammation (TII) and ESRD progression. CONCLUSIONS: Moderate-to-severe TID, but not TII, was a strong predictor of ESRD progression independent of eGFR or glomerular findings, therefore, providing an important window for potential early interventions.

Efecto de un programa de ejercicio físico extraescolar para el alineamiento postural de estudiantes de una institución educativa de la ciudad de Armenia (Colombia), hallazgos preliminares / Postural alignment and physical exercise extracurricular, preliminary findings

Objetivo: evaluar el efecto de un programa de ejercicio físico sobre el alineamiento postural en estudiantes de 8 a 11 años. Materiales y métodos: participaron once estudiantes de ambos sexos distribuidos aleatoriamente, el grupo experimental (GE, n= 6) con edad promedio 10,0±1,22 años; y el grupo control (GC, n=5) 9,5±0,54 años.El programa se ejecutó en 36 sesiones (duración: 45 min cada sesión. Frecuencia: 3 días por semana). El alineamiento postural fue evaluado por medio de la fotogrametría y analizado en el programa Kinovea 0.8.7. Resultados: los datos indicaronuna efectividad del programa de ejercicio físico disminuyendo el desalineamiento significativamente en regiones del mentón e infra-esternal en la vista anterior, vertex y cervical 7 en la vista posterior. El GC no presentó mejoras. Conclusión: el programa de ejercicio físico con una duración de 12 semanas y con una periodización linear reduce el desalineamiento postural existente y promueve el alineamiento corporal en escolares de 8 a 11 años. Las implicaciones a nivel clínico-educativo sugieren que sea recomendada la prescripción de ejercicios físicos específicos para la correcciónde desalineamientos posturales en esta franja etaria. Así mismo, a nivel científico se alienta a futuros trabajos en ésta línea y el control de otros factores ambientales...(AU)

Objective: to evaluate the effect of an exercise program on postural alignment students from 8 to 11 years. Materials end methods: a total of eleven students of both sexes randomized, experimental group (GE, n = 6) with mean age 10.0 ± 1.22 years; and control group (CG, n = 5) 9.50 ± 0.54 years. The program was implemented in 36 sessions (duration: 45 minutes each session. Frequency: 3 days per week). Postural alignment was evaluated by photogrammetry and analyzed in the Kinovea 0.8.7 program.Results: the data showed an effectiveness of exercise program significantly reducing the misalignment regions chin and breastbone lowin the previous view, vertex and cervical 7 in the rear view. The GC did not show improvements. Conclusion: the exercise program lasting 12 weeks and linear periodization reduces existing postural misalignment and promotes body alignment in school from 8 to 12 years. The implications for clinical and educational level suggests it is recommended prescribing specific physical exercises for the correction of postural misalignments in this age group. Also, to encourage scientific level future work in this line and control of other environmental factors...(AU)

A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions.

BACKGROUND & AIMS: After endoscopic mucosal resection (EMR) of colorectal lesions, delayed bleeding is the most common serious complication, but there are no guidelines for its prevention. We aimed to identify risk factors associated with delayed bleeding that required medical attention after discharge until day 15 and develop a scoring system to identify patients at risk. METHODS: We performed a prospective study of 1214 consecutive patients with nonpedunculated colorectal lesions 20 mm or larger treated by EMR (n = 1255) at 23 hospitals in Spain, from February 2013 through February 2015. Patients were examined 15 days after the procedure, and medical data were collected. We used the data to create a delayed bleeding scoring system, and assigned a weight to each risk factor based on the ß parameter from multivariate logistic regression analysis. Patients were classified as being at low, average, or high risk for delayed bleeding. RESULTS: Delayed bleeding occurred in 46 cases (3.7%, 95% confidence interval, 2.7%-4.9%). In multivariate analysis, factors associated with delayed bleeding included age ≥75 years (odds ratio [OR], 2.36; P < .01), American Society of Anesthesiologist classification scores of III or IV (OR, 1.90; P ≤ .05), aspirin use during EMR (OR, 3.16; P < .05), right-sided lesions (OR, 4.86; P < .01), lesion size ≥40 mm (OR, 1.91; P ≤ .05), and a mucosal gap not closed by hemoclips (OR, 3.63; P ≤ .01). We developed a risk scoring system based on these 6 variables that assigned patients to the low-risk (score, 0-3), average-risk (score, 4-7), or high-risk (score, 8-10) categories with a receiver operating characteristic curve of 0.77 (95% confidence interval, 0.70-0.83). In these groups, the probabilities of delayed bleeding were 0.6%, 5.5%, and 40%, respectively. CONCLUSIONS: The risk of delayed bleeding after EMR of large colorectal lesions is 3.7%. We developed a risk scoring system based on 6 factors that determined the risk for delayed bleeding (receiver operating characteristic curve, 0.77). The factors most strongly associated with delayed bleeding were right-sided lesions, aspirin use, and mucosal defects not closed by hemoclips. Patients considered to be high risk (score, 8-10) had a 40% probability of delayed bleeding.

Desarrollo del entorno personal de aprendizaje: valoración de una experiencia con estudiantes universitarios / Development of Personal Learning Environment: assessment of an experience with university students

En este trabajo se muestra los resultados de un estudio derivado de una experiencia cuyo objetivo es analizar el desarrollo del entorno personal de aprendizaje (PLE) de estudiantes universitarios de primer año. El colectivo participante queda compuesto por 96 estudiantes matriculados en el curso de Recursos Tecnológicos de Bachillerato en Orientación de la Universidad Nacional (Costa Rica). Tanto el diagnóstico inicial como la valoración final se obtienen por medio de un cuestionario en línea. De los principales resultados se deriva el poco desarrollo del PLE del estudiantado en el momento de ingresar a la universidad, la valoración positiva que realizan de desarrollo del PLE al finalizar el curso, así como la alta previsión de uso de las diferentes herramientas tanto a nivel personal como profesional.

This work presents the results of a study derived from an experience whose objective is to analyze the development of personal learning environment (PLE) in first-year university students. The participant group is composed of 96 students enrolled in the course of Technological Resources of Bachelor's Degree in Guidance of the Universidad Nacional de Costa Rica. The first diagnosis as well as the final assessment are obtained through an online questionnaire. The main results show the student body´s low development of PLE at the time of joining university, the positive assessment made about the development of PLE at the end of the course, as well as the high forecast use of the different tools, both at personal and professional level.

Prácticas profesionales educativas (PPE): reflexión desde la formación en educación física / Professional Education Internships(PEI): reflections on the formation of physical education teachers

En el presente escrito recolectamos las reflexiones producto de procesos experienciales en lo que se denomina las prácticas profesionales educativas; allí se configura un escenario, en el cual parece existir una lucha entre los postulados teóricos de las instituciones y de los autores y autoras formales, y la realidad de los sujetos que viven la práctica. Este hecho está matizado fundamentalmente en que la realidad de la experiencia del sujeto que está en formación para ser maestro o maestra, se aleja de los sueños de los currículos. Inquieta así, fundamentalmente, las estrechas condiciones para que los objetivos de las prácticas sean reales...

Concentración de Hg, Pb, Cd, Cr y As en hígado de Carcharhinus limbatus (Carcharhiniformes: Carcharhinidae) capturado en Veracruz, México

Concentration of Hg, Pb, Cd, Cr and As in liver Carcharhinus limbatus (Carcharhiniformes: Carcharhinidae) captured in Veracruz, Mexico. Pollution by heavy metals in marine ecosystems in the Gulf of Mexico is one of the hardest conservation issues to solve. Sharks as top predators are bioindicators of the marine ecosystem health, since they tend to bioaccumulate and biomagnify contaminants; they also represent a food source for local consumption. Thus, the objective of this study was to study the possible presence of heavy metals and a metalloid in livers of Carcharhinus limbatus. For this, a total of 19 shark livers were taken from animals captured nearby Tamihua, Veracruz, Mexico from December 2007 to April 2008. 12 out of the 19 captured sharks were males, one was an adult female, three were juvenile males, and three juvenile females. Four heavy metals (Hg, Pb, Cd, and Cr) and one metaloid (As) were analyzed in shark livers using an atomic absorption spectrophotometry with flame and hydride generator. Our results showed that the maximum concentrations found were: Hg=0.69mg/kg, Cd=0.43mg/kg, As=27.37mg/kg, Cr=0.70mg/kg. The minimum concentrations found were: As=14.91mg/kg, Cr=0.35mg/kg. The Pb could not be determined because the samples did not have the spectrophotometer minimum detectable amount (0.1mg/kg). None of the 19 samples analyzed showed above the permissible limits established by Mexican and American laws. There was a correlation between shark size and Cr and As concentration (Pearson test). The concentration of Cr and As was observed to be higher in bigger animals. There was not a significant difference in heavy metals concentration between juveniles and adults; however, there was a difference between males and females. A higher Cr concentration was found in females when compared to males. None of the samples exceed the maximum limit established by the laws of Mexico and the United States of America. Much longer studies are needed with C. limbatus and other species caught in the region, in order to determine the degree of contaminants exposure in aquatic ecosystems and to identify potential health risks to consumers.

La contaminación de los ecosistemas marinos y costeros por metales pesados en el Golfo de México es uno de los problemas que afectan a los recursos naturales del medio acuático. Los tiburones por situarse en niveles tróficos superiores de la red alimenticia acumulan y magnifican cantidades considerables de contaminantes. Por esta razón, el objetivo de este trabajo fue determinar la concentración de cuatro metales pesados (Hg, Cd, Pb y Cr) y un metaloide (As) en el tiburón punta negra (Carcharhinus limbatus) por medio de espectrofotometría de absorción atómica con flama y generador de hidruros. Se muestrearon 19 hígados de tiburones capturados cerca de Tamiahua, Veracruz entre noviembre 2007 y marzo 2008, de los cuales 12 fueron machos adultos, una hembra adulta, tres machos jóvenes y tres hembras jóvenes. Las concentraciones máximas registradas para cada metal fueron: Hg=0.69mg/ kg, Cd=0.43mg/kg, As=27.37mg/kg, Cr=0.35mg/kg. El Pb no fue detectado, no al menos la cantidad mínima de detección requerida por el espectrofotómetro de absorción atómica (0.1mg/kg). Ninguna de las muestras analizadas rebasó los límites máximos permisibles por las leyes mexicanas y americanas.

La salud en los gimnasios: una mirada desde la satisfacción personal / Gym health: a look from personal satisfaction / A saúde nos ginásios: desde a satisfação pessoal

Objetivo: identificar los motivos de adherencia y deserción de los centros de ejercicio físico y describir una de las relaciones halladas que se refiere a la “Satisfacción Personal” y la salud de los usuarios de los gimnasios de la ciudad de Manizales. Metodología: enfoque hermenéutico de tipo cualitativo con un método cuasi-etnográfico. Resultados: los que se expresan aquí se centran en la relación entre el deseo personal, la salud y los centros de ejercicio físico, básicamente en la configuración que se teje entre logros psíquicos, afectación positiva a los usuarios, logros fisiológicos, prevención de la enfermedad, logros estéticos y la construcción de conceptos saludables; esta construcción se realiza desde la percepción del los asistentes al gimnasio. Conclusión: existe una percepción de satisfacción personal en el gimnasio que está asociada a la configuración de lo psíquico, fisiológico y estético, lo cual está apalancado por la sociedad e historia de vida de los sujetos, y culmina instituyendo un concepto de bienestar al integrar diversas dimensiones del ser humano.

Objective: to identify the reasons for entering or abandoning the physical exercise centers and describe one of the relationships found related with the users’ “Personal Satisfaction” and health in the Gyms in the city of Manizales. Methodology: hermeneutic, qualitative type approach with a quasi-ethnographic method. Results: There results herby expressed are centered in the relationship between personal desire, health and physical exercise centers, basically in what is concerned with the configuration weaved between psychic outcomes, the users’ positive affectation, physiological outcomes, disease prevention, aesthetic outcomes, and the construction of healthy concepts; this construction is made from the perception of those attending the gym. Conclusion: There is a perception of personal satisfaction in the gym that is associated with the configuration of the psychic, the physiological and the aesthetic which is supported by society and the life history of the subjects and ends up instituting a welfare concept while integrating the diverse dimensions of the human being.

Objetivo: identificar os motivos de aderência e deserção dos centros de exercício físico e descrever uma das relações encontradas que se refere à “Satisfação Pessoal” e a saúde dos usuários nos ginásios da cidade de Manizales. Metodologia: enfoque hermenêutico de tipo qualitativo com um método quase etnográfico. Resultados: Os que se expressam aqui se centram na relação entre o desejo pessoal, a saúde e os centros de exercício físico, basicamente na configuração que se tece entre logros psíquicos, afetação positiva aos usuários, logros fisiológicos, prevenção da enfermidade, logros estéticos e a construção de conceitos saudáveis, esta construção se realiza desde a percepção dos assistentes ao ginásio. Conclusão: existe uma percepção de satisfação pessoal no ginásio que esta associada à configuração do psíquico, fisiológico e estético, o qual esta apalaçando pela sociedade e historia de vida dos sujeitos, e culmina instituindo um conceito de bem-estar ao integrar diversas dimensões do ser humano.

Perfil de fitness de los estudiantes de la Universidad de Caldas / Fitness profile of Universidad de Caldas students / Perfil de fitness dos estudantes da Universidade de Caldas

Objetivo: el objetivo del estudio fue identificar el perfil de fitness de los estudiantes de la Universidad de Caldas, en fuerza muscular abdominal y prensión manual, flexibilidad muscular dorsal e isquiotibial, resistencia aeróbica, porcentaje graso, índice de masa corporal (IMC) y perímetro de cintura, y la actividad física habitual. Material y Método: estudio cuantitativo, de corte transversal, con alcance descriptivo y correlacional, sobre un universo de 10.890 evaluó una muestra representativa probabilística de 370 estudiantes, de 33 programas de pregrado y postgrado, para un nivel de confianza del 95% con error estimado del 5%; se realizó entre marzo y octubre de 2008 en Manizales, Colombia. La técnica fue observación directa, siguiendo los protocolos antropométricos de la International Society for the Advancement of Kinanthropometry (ISAK) y los tests deportivo motores recomendados por la Asociación Colombiana de Medicina del Deporte (ACOMEDEF). Se recolectó la información en un instrumento desarrollado por el grupo, posteriormente digitada en Excel XP-2007 donde se calcularon medidas de tendencia central y dispersión. Resultados: los resultados muestran que en general el fitness de la comunidad estudiantil está por debajo de los valores esperados, con un elevado porcentaje de grasa; el riesgo cardiovascular por perímetro de cintura estuvo entre alto y muy alto para el 5,2% de los evaluados, el IMC mostró que un 7% está en peso bajo y el 21,6% en exceso. Conclusiones: la escasa actividad física realizada por la comunidad estudiantil se refleja en bajo nivel general de las capacidades condicionales y elevado porcentaje de grasa.

Objective: the identification of the fitness profile of Universidad de Caldas students, regarding abdominal muscle strength and hand grip, dorsal and hamstring muscular flexibility, aerobic resistance, body fat percentage, body mass index (BMI) and waist perimeter, and physical activity. Materials and methods: a quantitative study was carried out, with a cross-sectional character, and a descriptive and correlational scope. With a total population of 10,890 students, a probability sample of 370 students was evaluated, from 33 undergraduate and graduate programs, for a confidence level of 95% with the estimated margin of error of 5%. The study was carried out between March and October 2008 in Manizales, Colombia. The technique implemented was direct observation, using the anthropometric protocols of the International Society for the Advancement of Kinanthropometry (ISAK) and motor sports testing recommended by the Colombian Association of Sports Medicine. The data was collected on an instrument developed by the group, then processed in Excel XP-2007, which calculated measures of central tendency and dispersion. Results: the overall fitness of the student community is below the expected values, with a high percentage of body fat, cardiovascular risk in relation to waist perimeter was between high and very high for 5.2% of those evaluated. The BMI showed that 7% are underweight and 21.6% are overweight. Conclusions: the scarce physical activity performed by the student community is reflected in overall low level of conditional capacity and the high percentage of body fat.

Objetivo: o objetivo da pesquisa foi identificar o perfil de fitness dos estudantes da Universidade de Caldas, em força muscular abdominal e pressão manual, flexibilidade muscular dorsal e isquiotibial, resistência aeróbica, porcentagem grasso, índice de massa corporal (IMC) e perímetro da cintura, e a atividade física habitual. Material e Método: pesquisa quantitativa, de corte transversal, com o alcance descritivo e correlaciona sobre um universo de 10.890 avaliou uma amostra representativa probabilística de 370 estudantes, de 33 programas de pré-grau e post-graduação, para um nível de confiança do 95% com erro estimado do 5%; se realizou entre março e outubro de 2008 em Manizales, Colômbia. A técnica de observação direita, seguindo os protocolos antropométricos da Internacional Society for the Advancement of kinanthropometry (ISAK) e os testes esportivos motores recomendados pela Associação Colombiana de Medicina do esporte (ACOMEDEF). Recolheu-se a informação num instrumento desenvolvido pelo grupo, posteriormente digitada em Excel XP-2007 onde se calcularam medidas de tendência central e dispersão. Resultados: os resultados amostram que em geral o fitness da comunidade estudantil esta por debaixo dos valores esperados, com uma elevada porcentagem de grassa; o risco cardiovascular por perímetro de cintura esteve entre alto e muito alto para El 5,2% dos avaliados, o IMC amostrou que um 7% esta em peso baixo e o 21,6% em excesso. Conclusões: a escassa atividade física realizada pela comunidade estudantil se reflexa em baixo nível geral das capacidades condicionais e elevado porcentagem de grassa.