Pleural effusion in a child with a correctly placed ventricle-peritoneal shunt.

Pleural effusions in children (PE) due to ventricle-peritoneal shunt (VPS) is very rare, with few cases reported. We present a new case of an infant with VPS who had a massive hydrothorax not associated with misplacement or migration of the distal catheter or with ascites. After the evacuation of the PE we managed the patient by adjusting the pressure of the adjustable valve (AV). Sequential thoracic ultrasounds showed a satisfactory outcome. We review the literature thoroughly and describe the possible pathophysiological mechanisms.

State of research, feasibility, safety, acceptability, and outcomes examined on remotely delivered exercises using technology for older adult with cancer: a scoping review.

INTRODUCTION: Technology-based exercise is gaining attention as a promising strategy for increasing physical activity (PA) in older adults with cancer (OACA). However, a comprehensive understanding of the interventions, their feasibility, outcomes, and safety is limited. This scoping review (1) assessed the prevalence and type of technology-based remotely delivered exercise interventions for OACA and (2) explored the feasibility, safety, acceptability, and outcomes in these interventions. METHODS: Studies with participant mean/median age ≥ 65 reporting at least one outcome measure were included. Databases searched included the following: PubMed, CINAHL, Embase, Cochrane Library Online, SPORTDiscus, and PsycINFO. Multiple independent reviewers completed screening and data abstractions of articles in English, French, and Spanish. RESULTS: The search yielded 2339 citations after removing duplicates. Following title and abstract screening, 96 full texts were review, and 15 were included. Study designs were heterogeneous, and sample sizes were diverse (range 14-478). The most common technologies used were website/web portal (n = 6), videos (n = 5), exergaming (n = 2), accelerometer/pedometer with video and/or website (n = 4), and live-videoconferencing (n = 2). Over half (9/15) of the studies examined feasibility using various definitions; feasibility outcomes were reached in all. Common outcomes examined include lower body function and quality of life. Adverse events were uncommon and minor were reported. Qualitative studies identified cost- and time-savings, healthcare professional support, and technology features that encourage engagement as facilitators. CONCLUSION: Remote exercise interventions using technology appear to be feasible and acceptable in OACA. IMPLICATIONS FOR CANCER SURVIVORS: Some remote exercise interventions may be a viable way to increase PA for OACA.

The effect of nut growth limitation on triose phosphate utilization and downregulation of photosynthesis in almond.

There is a controversy regarding when it is appropriate to apply the irrigation restriction in almond trees (Prunus dulcis Mill.) to save water without penalizing yield. We hypothesized that knowing when plants demand fewer photoassimilates would be a good indicator of less sensitivity of the crop to water deficit. One parameter that defines the photosynthetic capacity is the triose phosphate utilization (TPU). Due to its connection to the export of sugars from the leaves to other sink organs, it is a good candidate for being such an indicator. The objective was to analyze the seasonal evolution of the photosynthetic capacity of three almond cultivars (cvs Guara, Marta and Lauranne) subjected to water stress during vegetative, kernel-filling and postharvest stages. Two sustained deficit irrigation (SDI) treatments (SDI75 and SDI65 with water reductions of 25 and 35%, respectively) and a control treatment (FI) consisting of fully irrigated trees were applied. The response of curves AN-Ci was analyzed to assess the maximum carboxylation rate (Vcmax), maximum rate of electron transport (Jmax), TPU and mesophyll conductance to CO2. In addition, leaf water potential and yield were measured. Our experimental findings showed any significant differences in the variables analyzed among cultivars and irrigation treatments. However, consistent differences arose when the results were compared among the phenological stages. During the kernel-filling and the postharvest stages, a progressive limitation by TPU was measured, suggesting that the demand for photoassimilates by the plant was reduced. This result was supported by the correlation found between TPU and fruit growth rate. As a consequence, a downregulation in Jmax and Vcmax was also measured. This study confirms that the kernel-filling stage might be a good time to apply a reduction in the irrigation and suggests a method to detect the best moments to apply a regulated deficit irrigation in almond trees.

Evaluation of a hybrid vertical membrane bioreactor (HVMBR) for wastewater treatment.

A new hybrid membrane bioreactor (HMBR) has been developed to obtain a compact module, with a small footprint and low requirement for aeration. The aim of this research was to assess its performance. The system consists of a single vertical reactor with a filtration membrane unit and, above this, a sponge fixed bed as support medium. The aeration system is located under the membrane unit, allowing for membrane cleaning, oxygenation, biofilm thickness control and bulk liquid mixing. Operated under continuous aeration, a bench-scale reactor (70 L) was fed with pre-treated, raw (unsettled) municipal wastewater. BOD(5) and suspended solids removal efficiencies (96 and 99% respectively) were comparable to those obtained with other membrane bioreactors (MBRs). Total nitrogen removal efficiencies of 80% were achieved, which is better than those obtained in other HMBRs and similar to the values reached using more complex MBRs with extra anoxic tanks, intermittent aeration or internal deflectors.

Distribution of the concentration of heavy metals associated with the sediment particles accumulated on road surfaces.

The heavy metal pollution caused by road run-off water constitutes a problem in urban areas. The metallic load associated with road sediment must be determined in order to study its impact in drainage systems and receiving waters, and to perfect the design of prevention systems. This paper presents data regarding the sediment collected on road surfaces in the city of Torrelavega (northern Spain) during a period of 65 days (132 samples). Two sample types were collected: vacuum-dried samples and those swept up following vacuuming. The sediment loading (g m(-2)), particle size distribution (63-2800 microm) and heavy metal concentrations were determined. The data showed that the concentration of heavy metals tends to increase with the reduction in the particle diameter (exponential tendency). The concentrations ofPb, Zn, Cu, Cr, Ni, Cd, Fe, Mn and Co in the size fraction <63 microm were 350, 630, 124, 57, 56, 38, 3231, 374 and 51 mg kg(-1), respectively (average traffic density: 3800 vehicles day(-1)). By increasing the residence time of the sediment, the concentration increases, whereas the ratio of the concentration between the different size fractions decreases. The concentration across the road diminishes when the distance between the roadway and the sampling siteincreases; when the distance increases, the ratio between size fractions for heavy metal concentrations increases. Finally, the main sources of heavy metals are the particles detached by braking (brake pads) and tyre wear (rubber), and are associated with particle sizes <125 microm.

Enhancing Nut Quality Parameters and Sensory Profiles in Three Almond Cultivars by Different Irrigation Regimes.

The climate change is already affecting many agricultural systems and human environments, and the implementation of adaptation strategies, especially those related to irrigated agriculture in semiarid regions, is urgent. In this regard, deep knowledge about the effects that irrigation has on the food quality parameters will allow us to estimate the potential benefits of deficit irrigation (DI) strategies. This work presents the effects on the quality parameters of three almond cultivars (Marta, Guara, and Lauranne) subjected to three irrigation doses: (i) full-irrigated treatment (FI) at 100% crop evapotranspiration (ETC), (ii) an overirrigated treatment at 150% ETC (150% ETC), and (iii) regulated deficit irrigation (RDI65) treatment, in which irrigation was done as in FI, expect during the kernel-filling period when this treatment received 65% ETC. According to experimental findings, the cultivar most sensitive to water stress was Marta, having the most significant improvements for RDI65. In general, the effects of the irrigation dose on the morphological and physicochemical parameters were not huge but some improvements were observed in key parameters such as the color and contents of specific sugars, organic acids, and unsaturated fatty acids. Thus, it can be concluded that the irrigation dose did not drastically affect the fruit almond quality, although it is possible to improve several key parameters when a moderate RDI strategy is applied.

Mass transfer enhancement and improved nitrification in MABR through specific membrane configuration.

One of the main energy consumptions in wastewater treatment plants (WWTPs) is due to the oxygenation of aerobic biological processes. In order to approach to an energy self-sufficient scenario in WWTPs, Membrane Aerated Biofilm Reactors (MABRs) provide a good opportunity to reduce the impact of aeration on the global energy balance. However, mass transfer limitations derived from poor flow distribution must be tackled to take advantage of this technology. In this work, in order to improve mass transfer between biofilm and bulk water, a specific configuration was developed and studied at laboratory scale, aimed at compactness, energy efficiency and high nitrification rates. Nitrification rates were higher in the innovative configuration than in the conventional one, achieving a Volumetric Nitrification Rate (VNR) as high as 575.84 g NH4-N m-3 d-1, which is comparable with confirmed technologies. Regarding energy consumption due to aeration, a reduction of 83.7% was reached in comparison with aeration through diffusers with the same Oxygen Transfer Efficiency (OTE). These results highlight the importance of hydrodynamic conditions and the membranes configuration on treatment performance.

Particle size distribution of accumulated sediments on an urban road in rainy weather.

The study of the behavior of deposited sediments on an urban surface serves to determine its characteristics of build-up, in dry periods, and of wash-off, during a rain event. Thus, these can be used later to indicate the presence of pollutants in an area. This paper presents data regarding the sediment collected on a road surface in the city of Torrelavega in northern Spain during a period of 65 days during which 132 samples were collected. The rainfall during the sampling period corresponded to 29% of the total rainfall registered in the same year. Two types of sediment collection samples were obtained: vacuumed dry samples (free load) and those swept up following vacuuming (fixed load). For each type of collected sample, the sediment loading, particle size distribution in seven fractions and moisture were determined. The data showed that the sediment loading (g m(-2)) and vacuumed availability of the load that was more strongly adhered to the surface, "fixed load", increases with the number of dry days. The particle size distribution of the collected sediment tended to be finer with the increase in number of dry days. Particle sizes less than 125 microm presented the greater rate of accumulation in dry weather and those less than 500 microm, the greater susceptibility to being washed off during a storm event.

[The effect of age on the prognosis of patients with traumatic brain injury who undergo a craniotomy: analysis of a surgical series]. / Efecto de la edad en el pronostico de pacientes con traumatismo craneoencefalico sometidos a craneotomia: analisis de una serie quirurgica.

INTRODUCTION: In our setting, the ageing of the population has led to management of traumatic brain injury (TBI) in the later stages of life becoming an increasingly frequent problem. AIM: To evaluate the association between age and the functional and survival prognosis of patients who have undergone surgery due to TBI. PATIENTS AND METHODS: We performed a retrospective analysis of a series of 404 patients submitted to surgery between the years 2000 and 2015: 144 youngsters (12-44 years), 77 adults (45-64 years), 148 geriatric patients (65-79 years) and 26 'super geriatric' patients (> 80 years). We reviewed the demographic and nosological characteristics of the population, the survival and functional prognosis (Glasgow Outcome Scale, GOS) on discharge and at six months. RESULTS: Age presents a positive linear association with both intra-hospital mortality and the proportion of patients with an unfavourable prognosis (GOS 1-3) on hospital discharge and at six months (p < 0.001). Taking the population of youngsters as a reference, the relative risk for an unfavourable prognosis at six months was 1.5 (95% CI: 1.04-2.19) for adults; 2.37 (95% CI: 1.77-3.17) for the geriatric patients; and 3.5 (95% CI: 2.63-4.7) for the 'super geriatric' patients. These latter present a mortality rate while in hospital of 77.78% and a percentage of poor functional prognosis at six months of 94.44%. CONCLUSION: Increased age is a major negative determining factor in the prognosis of patients who undergo a craniotomy due to TBI. More precise knowledge of these outcomes and an adequate pre-operative discussion with the family will be an invaluable aid in the decision-making process.

TITLE: Efecto de la edad en el pronostico de pacientes con traumatismo craneoencefalico sometidos a craneotomia: analisis de una serie quirurgica.Introduccion. En nuestro entorno, el envejecimiento poblacional ha convertido el manejo del traumatismo craneoencefalico (TCE) en etapas avanzadas de la vida en un problema de frecuencia creciente. Objetivo. Valorar la asociacion entre la edad y el pronostico vital y funcional de pacientes intervenidos por TCE. Pacientes y metodos. Analizamos retrospectivamente una serie de 404 pacientes intervenidos en nuestro centro entre los años 2000 y 2015: 144 jovenes (12-44 años), 77 adultos (45-64 años), 148 pacientes geriatricos (65-79 años) y 26 supergeriatricos (> 80 años). Revisamos las caracteristicas demograficas y nosologicas de la poblacion, y el pronostico vital y funcional (escala pronostica de Glasgow, GOS) en el momento del alta y a los seis meses. Resultados. La edad presenta asociacion lineal positiva tanto con la mortalidad intrahospitalaria como con la proporcion de pacientes con pronostico desfavorable (GOS 1-3) en el alta y a los seis meses (p < 0,001). Tomando como referencia la poblacion de jovenes, el riesgo relativo para pronostico desfavorable a los seis meses fue de 1,5 (IC 95%: 1,04-2,19) para los adultos, 2,37 (IC 95%: 1,77-3,17) para los geriatricos y 3,5 (IC 95%: 2,63-4,70) para los supergeriatricos. Estos ultimos presentan una mortalidad durante el ingreso del 77,78% y un porcentaje de mal pronostico funcional a los seis meses del 94,44%. Conclusion. El aumento de la edad es un factor determinante negativo mayor en el pronostico de pacientes sometidos a craneotomia por TCE. Un conocimiento preciso de estos resultados y una adecuada discusion preoperatoria con la familia resultaran de gran ayuda en el proceso de toma de decisiones.

Characterisation of solid and liquid fractions of dairy manure with regard to their component distribution and methane production.

Dairy manure with a total solids content of 77.2g TS/l was separated by means of screening and coagulation-flocculation treatments, using CaO as coagulant and a cationic polyacrylamide as flocculant, obtaining liquid and solid fractions. The solid fraction separated contained 33.4% of the initial total mass of dairy manure plus chemical solutions, containing also 75.2% of the TS, 80.4% of the VS, 58.5% of the total Kjeldahl nitrogen (TKN) and 87.4% of the total phosphorus (P(T)) present in the initial dairy manure. 83.7% of the liquid fraction chemical oxygen demand (COD) was anaerobically biodegradable (COD(BD)). Methane production for the separated liquid fraction was 0.604l CH4 NCTP/g VS added, being 0.307 and 0.371l CH4 NCTP/g VS added for dairy manure and screened dairy manure, respectively. The characteristics of this liquid fraction would allow its treatment in high loading anaerobic reactors having shorter hydraulic retention times, smaller reactor size and a higher methane volumetric production rate than conventional anaerobic reactors treating either manure or screened manure.

Abrupt homeostatic responses to transient intracardiac occlusion during balloon valvuloplasty.

The present study analyzes the hemodynamics of intracardiac occlusive periods during balloon mitral or aortic valvuloplasty and compares them with immediate plasma levels of atrial natriuretic factor (ANF), vasopressin and renin activity. Forty-nine patients were studied; 33 of them had mitral stenosis and 16 had aortic stenosis. The mean age was 52 +/- 17 years. During dilations pressures were monitored from the ascending aorta and left atrium. Plasma levels of ANF, vasopressin and renin were serially determined at baseline, after diagnostic procedures, within 15 to 30 seconds after the first 2 occlusive dilations, and 1 and 7 hours later. There were no significant changes in plasma renin throughout the study stages. ANF and vasopressin significantly increased after the dilations. These hormonal changes were related to the significant hemodynamic changes observed during intracardiac occlusion. The left atrial pressure correlated directly and significantly (r = 0.54, p less than 0.001) with plasma ANF levels throughout the conditions. On the other hand, the plasma vasopressin also correlated (r = 0.76, p less than 0.001) with systemic pressure in an exponential fashion. These findings show that abrupt releases of ANF and vasopressin occur immediately after intracardiac occlusive periods as a response to the acute and transient hemodynamic changes observed.

[Long-term clinical course of acute myocarditis. Prospective study of a series of 99 patients (1987-1995)]. / Evolución a largo plazo de la miocarditis aguda. Estudio prospectivo de una serie de 99 pacientes (1987-1995).

BACKGROUND: The natural history of acute myocarditis is not well known. The aim of our study was to assess the spontaneous outcome of patients with this disease and its possible relation with progression to chronic dilated cardiomyopathy. METHODS: With this aim, we have carried out a prospective study of 99 patients consecutively diagnosed with acute myocarditis in our hospital from 1987 to April 1995, with a mean follow-up of 34 +/- 25 months. Acute myocarditis was diagnosed by clinical, echocardiographic and isotopic (detection of myocite damage) data, in absence of any other cardiac lesion. RESULTS: Mean age was 26 +/- 17 years; 70% of the patients were male. Initial symptoms were dyspnea in 58% of the patients, chest pain in 33% and arrhythmias in 9%. Severe heart failure was present in 62% of the patients, ventricular arrhythmias in 16% and supraventricular arrhythmias in 16%. Cardiothoracic index was 0.50 +/- 0.07. Left ventricular ejection fraction was 0.40 +/- 0.18, although in 44% of the patients it was lower than 0.30. Immunosuppressive therapy was not used in any case. Outcome was favorable in 70% of the patients, who had a normal ejection fraction, while 13% died or needed heart transplantation during follow-up and 17% progressed to stable chronic dilated cardiomyopathy. Final ejection fraction was 0.53 +/- 0.17, significantly higher than the initial, 0.40 +/- 0.18 (p < 0.05); this improvement in ejection fraction was mainly observed during the first month after diagnosis (0.49 +/- 0.18). The proportion of patients with an ejection fraction of less than 0.30 decreased from 44% to 21% at the end of follow-up. CONCLUSIONS: Spontaneous outcome of acute myocarditis is good in the majority of patients, although an unfavourable evolution was observed in almost 30% of the patients (death, need of heart transplantation or chronic dilated cardiomyopathy). Improvement in ventricular function mainly occurs at short-term, during the first month of evolution in our study.

[Acute myocarditis with severe cardiac dysfunction in the pediatric population. The evolution and differential characteristics with respect to adult myocarditis]. / Miocarditis aguda con disfunción cardíaca severa en la problación pediátrica. Evolución y características diferenciales con respecto a la miocarditis del adulto.

AIMS: The aim of our study was to assess the spontaneous outcome of acute myocarditis associated with severe cardiac dysfunction in children, as well as to compare these features with those occurring in adult patients. METHODS: Fifty patients consecutively diagnosed of acute myocarditis during the last 7 years in our hospital were studied; 15 patients were children younger than 14 years, and 35 were adults. Immunosuppressive therapy was not used in any patient. RESULTS: Mean age was 2 +/- 3 years in children, ranging from 2 months to 12 years. One patient required temporary pacing for a third-degree atrioventricular block, while the remaining 14 children had severe congestive heart failure, with a left ventricular ejection fraction of 30 +/- 12% (16 to 44%). After a mean follow-up of 21 +/- 26 months, only 3 children died, at 1, 4 and 10 months after the initial diagnosis. Death was sudden in all 3 patients. Left ventricular ejection fraction rose to 45 +/- 14% at 1 month after diagnosis, and to 58 +/- 15% at the end of follow-up. Unfavorable evolution (death or evolution to chronic dilated cardiomyopathy, with a left ventricular ejection fraction < 45%) occurred in 6 children (40%) at 1 month after diagnosis and in only 4 (25%) at the end of follow-up. The 9 children with 1-month favorable outcome were alive and had an ejection fraction > 45% at long-term, while only 2 of the 6 children with 1-month unfavorable outcome were alive and had an ejection fraction > 45% at long-term. Only the 3 children who died had an ejection fraction < 30% at 1-month. Favorable outcome was more frequent in children that in adult patients with acute myocarditis (75% versus 46%). CONCLUSIONS: The outcome of acute myocarditis with severe cardiac dysfunction was favorable in a majority of pediatric patients; this favorable evolution was less frequent in adults. Patients in whom left ventricular ejection fraction did not increase at short-term had a higher risk of death, and they should probably be considered for heart transplantation.

[Infectious endocarditis in non-addict patients without predisposing heart disease. Differential features]. / Endocarditis infecciosa en pacientes no drogadictos sin cardiopatía predisponente. Características diferenciales.

INTRODUCTION AND AIMS: Although uncommonly, infective endocarditis in non-addict patients may involve people without predisponente heart disease. The aim of our study was to assess the clinical and prognostic features of this type of endocarditis and to compare them with those of the more common type of endocarditis with underlying lesion. METHODS: With this aim, we have reviewed 71 consecutive cases of non-addict infective endocarditis diagnosed in our hospital in the last 7 years; there was no preexisting cardiac lesion in 9 patients (13% of all endocarditis and 21% of native valve endocarditis), while underlying heart disease, including mitral valve prolapse, was present in the remaining 62 patients. RESULTS: Mean age was significantly lower in 9 patients without preexistent lesion (28 +/- 18 versus 46 +/- 17 years, p < 0.01), while there was no differences for gender. Infection involved the aortic valve in 56%, the tricuspid or pulmonary valve in 33% and the mitral valve in only 11% of the patients without underlying cardiopathy (for 44%, 4% and 49%, respectively, in patients with cardiopathy). Staphylococcus aureus caused 67% of cases in patients without cardiopathy and only 9% in those with cardiopathy. Surgery was required in a similar proportion by both groups of patients (55% and 56%), although mortality was more than twice higher in patients with prior cardiac lesions (25% versus 11%). CONCLUSIONS: A significant proportion of non-addict infective endocarditis involves patients without predisponente heart disease. These cases have some differential features (younger age, aortic and right heart valves involvement, S. aureus as the main causative agent and lower mortality) in comparison to those of endocarditis in patients with underlying cardiopathy.

Environmental engineering education in Spain.

There is a growing demand for engineers and technologists who show multidisciplinary expertise to deal with environmental issues. As a result of this demand, most countries are adapting their old university programs on environmental engineering education. In Spain an official environmental engineering degree does not yet exist, but the Council of Universities is working to present a proposal, based on Bologna agreement concepts. The paper summarizes not only the future perspectives of environmental engineering education in Spain, but also the evolution of the approach during the last decades, which includes the role of the private initiative, the environmental sciences degree, and the intensification in different traditional engineering degrees. Finally, the paper briefly details and compares the syllabus developed in the only four Spanish universities where environmental engineering is offered as a non-official post-graduate course lasting two years.

Detention storage volume for combined sewer overflow into a river.

This article discusses the storage volume needed in a combined sewer system tank in order to preserve the water quality. There are a lot of design criteria which do not take into account the conditions of the receiving water, and as a result are inappropriate. A model was used to simulate the performance of a theoretical combined sewer system where a tank was located downstream. Results were obtained from the overflows produced by the rain recorded in Santander (Spain) for 11 years, with several combinations of storage volume and treatment capacity in the wastewater treatment plant. Quality criteria were also proposed for faecal coliforms, BOD, and total nitrogen to evaluate the effects from the overflows in the river water quality. Equations have been obtained which relate the number of overflows, the storage volume and the treatment plant capacity. The bacteriological pollution, quantified by means of faecal coliforms, was the analytical parameter which produced the most adverse effects in the river, so that more storage volume is needed (45 to 180 m3 ha(-1) net) than with other simulated pollutants (5 to 50 m3 ha(-1) net for BOD, and less than 4 m3 ha(-1) net for the total nitrogen). The increase in the treatment plant's capacity, from two to three times the flow in dry weather, reduces the impact on the river water in a more effective way, allowing a reduction of up to 65% in the number of overflows rather than increasing the storage volume.

[Infrequent association: massive inguinoscrotal bladder hernia, multiple scrotal lithiasis, and bilateral obstructive uropathy]. / Una asociación poco frecuente: hernia vesical inguinoescrotal masiva, litiasis escrotal múltiple y uropatía obstructiva bilateral.

Vesical hernias occur in a significant number of patients with inguinal hernia, though massive inguinoscrotal vesical hernias are uncommon. This paper presents a case report of a male patient where massive inguinoscrotal vesical hernia, and scrotum-located multiple vesical lithiasis was associated to a large amount of lithiasic mass and bilateral ureterohydronephrosis. We consider this association of urinary conditions extremely rare, since to our knowledge bilateral ureterohydronephrosis has only been formerly documented in one case.

Comparison between a fixed bed hybrid membrane bioreactor and a conventional membrane bioreactor for municipal wastewater treatment: a pilot-scale study.

A hybrid membrane bioreactor (HMBR) was developed, by adding biofilm support media into a conventional membrane bioreactor (CMBR), and operated in parallel with a CMBR. Results showed that effluent quality was significantly better with the HMBR. The removal efficiencies of COD, BOD5, NH4(+)-N and TN with the HMBR were 84%, 98%, 97% and 75%, respectively, as compared to 80%, 96%, 93% and 38% with the CMBR. There were no differences in phosphorus removal. The membrane fouling rate in the HMBR was on average only 57% of that in the CMBR. The lower concentration of colloidal biopolymer clusters in the HMBR sludge, probably due to their retention by the biofilm, could be partially responsible for this difference. Filterability and settleability of the sludge were also better in the HMBR. Consequently, it is concluded that the addition of fixed support media for biofilm growth can improve the performance of CMBRs.