Consensus on complementary feeding from the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition: COCO 2023.

Complementary feeding (CF) is defined as the feeding of infants that complements breastfeeding, or alternatively, feeding with a breast milk substitute, and is a process that is more than simply a guide as to what and how to introduce foods. The information provided by healthcare professionals must be up-to-date and evidence-based. Most of the recommendations that appear in the different international guidelines and position papers are widely applicable, but some must be regionalized or adapted to fit the conditions and reality of each geographic zone. The Nutrition Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) summoned a group of experts from each of the society's member countries, to develop a consensus on CF, incorporating, whenever possible, local information adapted to the reality of the region. The aim of the present document is to show the results of that endeavor. Utilizing the Delphi method, a total of 34 statements on relevant aspects of CF were evaluated, discussed, and voted upon.

CNS Hypomyelination Disrupts Axonal Conduction and Behavior in Larval Zebrafish.

Myelination is essential for central nervous system (CNS) formation, health and function. As a model organism, larval zebrafish have been extensively employed to investigate the molecular and cellular basis of CNS myelination, because of their genetic tractability and suitability for non-invasive live cell imaging. However, it has not been assessed to what extent CNS myelination affects neural circuit function in zebrafish larvae, prohibiting the integration of molecular and cellular analyses of myelination with concomitant network maturation. To test whether larval zebrafish might serve as a suitable platform with which to study the effects of CNS myelination and its dysregulation on circuit function, we generated zebrafish myelin regulatory factor (myrf) mutants with CNS-specific hypomyelination and investigated how this affected their axonal conduction properties and behavior. We found that myrf mutant larvae exhibited increased latency to perform startle responses following defined acoustic stimuli. Furthermore, we found that hypomyelinated animals often selected an impaired response to acoustic stimuli, exhibiting a bias toward reorientation behavior instead of the stimulus-appropriate startle response. To begin to study how myelination affected the underlying circuitry, we established electrophysiological protocols to assess various conduction properties along single axons. We found that the hypomyelinated myrf mutants exhibited reduced action potential conduction velocity and an impaired ability to sustain high-frequency action potential firing. This study indicates that larval zebrafish can be used to bridge molecular and cellular investigation of CNS myelination with multiscale assessment of neural circuit function.SIGNIFICANCE STATEMENT Myelination of CNS axons is essential for their health and function, and it is now clear that myelination is a dynamic life-long process subject to modulation by neuronal activity. However, it remains unclear precisely how changes to myelination affects animal behavior and underlying action potential conduction along axons in intact neural circuits. In recent years, zebrafish have been employed to study cellular and molecular mechanisms of myelination, because of their relatively simple, optically transparent, experimentally tractable vertebrate nervous system. Here we find that changes to myelination alter the behavior of young zebrafish and action potential conduction along individual axons, providing a platform to integrate molecular, cellular, and circuit level analyses of myelination using this model.

Educación Deportiva versus Enseñanza Tradicional: influencia sobre la regulación motivacional en alumnado de Bachillerato / Educação Desportiva versus Ensino Tradicional: influência sobre a regulação motivacional de alunos do Ensino Médio / Sport Education versus Traditional Teaching: influence on motivational regulation in High School students

El objetivo de esta investigación fue analizar el impacto de una intervención basada en el Modelo de Educación Deportiva (MED), en comparación con el Modelo de Enseñanza Tradicional (MET), sobre la regulación motivacional en alumnado de bachillerato en clase de Educación Física. Participó un total de 44 estudiantes (22 hombres y 22 mujeres, Medad = 16.32, DT = 0.57) de bachillerato. El diseño fue un estudio cuasi-experimental con medidas pre- y post-test y comparaciones intra- e inter-grupo. El programa de intervención consistió en 12 sesiones para la enseñanza del baloncesto, siguiéndose las directrices recomendadas por la literatura tanto para el grupo MED como para el grupo MET. Los resultados han indicado que el MED, respecto al MET, mejoró significativamente el nivel de motivación intrínseca y de regulación identificada. Los hallazgos también han mostrado como el MED redujo significativamente el nivel de regulación externa y desmotivación comparado con el MET. Como conclusión, el MED es un modelo de enseñanza deportiva que favorece el desarrollo de las regulaciones de motivación más autodeterminadas (motivación intrínseca y regulación identificada) en el proceso de enseñanza-aprendizaje en el contexto escolar, lo que podría suscitar el interés en el alumnado por la práctica deportiva de modo regular en el tiempo libre (AU)

O objetivo dessa investigação foi analisar o impacto de uma intervenção baseada no Modelo de Educação Desportiva (MED), em comparação com o Modelo de Ensino Tradicional (MET), sobre a regulação motivacional de alunos do Ensino Médio em aulas de Educação Física. O total de participantes foi de 44 estudantes (22 homens e 22 mulheres, Midade = 16.32, DT = .57). O desenho do estudo se configurou como quase-experimental com medidas pré - e pós-teste e comparações intra- e inter- grupo. O programa de intervenção consistiu em 12 sessões para o ensino do basquetebol, seguindo as diretrizes recomendadas pela literatura para o grupo MED e para o grupo MET. Os resultados indicaram que o MED, com relação ao MET, melhorou significativamente o nível de motivação intrínseca e de regulação identificada. As descobertas também mostraram que o MED reduziu significativamente o nível de regulação externa e desmotivação comparado com o MET. Como conclusão, o Modelo de Educação Desportiva é um modelo de ensino desportivo que favorece o desenvolvimento das regulações de motivação mais autodeterminadas (motivação intrínseca e regulação identificada) no processo de ensino-aprendizagem no contexto escolar, o que poderia suscitar o interesse dos alunos pela prática desportiva de modo regular em seu tempo livre (AU)

The objective of this research was to examine the influence of an intervention based on Sport Education Model (SEM), in comparison with Traditional Teaching Model (TTM), on motivational regulation in high school students in Physical Education class. A total of 44 high school students (22 men and 22 women, Mage = 16.32, SD = .57) participated. The design was a quasi-experimental study with pre- and post-test measures and intra- and inter-group analysis. The intervention consisted of 12 sessions for teaching of basketball, following the guidelines recommended by literature both for the SEM group and for the TTM group. The results have indicated that SEM significantly improved the level of intrinsic motivation and of identified regulation in relation to TTM. The findings have also showed that SE has significantly reduced the level of external regulation and of amotivation in the students regarding TTM. In conclusion, SEM is a teaching model of sport which encourage the development of the most selfdetermined regulations of motivation (intrinsic motivation and identified regulation) in teaching-learning process in school setting, which could arouse the interest of students for regular practice of sport in free time (AU)

Verification of fetal brain responses by coregistration of fetal ultrasound and fetal magnetoencephalography data.

Fetal magnetoencephalography (fMEG) is used to study neurological functions of the developing fetus by measuring magnetic signals generated by electrical sources within the fetal brain. For this aim either auditory or visual stimuli are presented and evoked brain activity or spontaneous activity is measured at the sensor level. However a limiting factor of this approach is the low signal to noise ratio (SNR) of recorded signals. To overcome this limitation, advanced signal processing techniques such as spatial filters (e.g., beamformer) can be used to increase SNR. One crucial aspect of this technique is the forward model and, in general, a simple spherical head model is used. This head model is an integral part of a model search approach to analyze the data due to the lack of exact knowledge about the location of the fetal head. In the present report we overcome this limitation by a coregistration of volumetric ultrasound images with fMEG data. In a first step we validated the ultrasound to fMEG coregistration with a phantom and were able to show that the coregistration error is below 2 cm. In the second step we compared the results gained by the model search approach to the exact location of the fetal head determined on pregnant mothers by ultrasound. The results of this study clearly show that the results of the model search approach are in accordance with the location of the fetal head.

Diversidad de pseudomonas fluorescentes en cultivos de papa de la región Cundiboyacense y su actividad antagonista in vitro sobre Rhizoctonia solani / Diversity of Fluorescent Pseudomonas in Potato Crops of the Cundiboyacense Region and its in vitro Antagonic Activity against Rhizoctonia solani

Las pseudomonas fluorescentes son unas de las bacterias benéficas más importantes a nivel de la rizosfera gracias a que pueden controlar algunos fitopatógenos habituales del suelo como resultado de su capacidad antagonista. Hay muy pocos trabajos realizados para conocer la composi-ción y diversidad de pseudomonas fluorescentes en paí-ses tropicales. En este trabajo se determinó la composi-ción de pseudomonas fluorescentes provenientes de dife-rentes cultivos de papa ubicados en la región Cundiboyacense, entre 2.100 y 3.200 msnm, la cual es considerada la zona de mayor producción de papa de Colombia. Así mismo se evaluó el efecto de algunas prác-ticas de cultivo sobre dicha composición. Finalmente se determinó la capacidad de antagonismo de algunos aisla-mientos de pseudomonas fluorescentes contra Rhizoctonia solani. Fueron evaluadas 45 muestras de rizosfera y rizoplano de cultivos de papa provenientes de 15 campos de papa diferentes. Las muestras se procesaron usando una modificación del medio King B, la cual resultó ser más eficiente para aislar pseudomonas fluorescentes, que otras reportadas en la literatura. El 80,7por cien y 82,7por cien de las pseudomonas fluorescentes aisladas en rizosfera y rizoplano, respectivamente, fueron Pseudomonas fluorescens, mostrando poca diversidad en las muestras evaluadas. Por otra parte se observó un efecto de la estra-tegia de rotación de cultivo maíz-papa, sobre el número de pseudomonas fluorescentes aisladas de la rizosfera. Estos resultados tienen implicaciones para el diseño de estrategias de manejo integrado de plagas en los cultivos de los países tropicales.

Prognostic significance of pathological response of primary tumor and metastatic axillary lymph nodes after neoadjuvant chemotherapy for locally advanced breast carcinoma.

PURPOSE: The prognostic significance of pathological response of primary tumor and metastatic axillary lymph nodes after neoadjuvant chemotherapy was assessed in patients with noninflammatory locally advanced breast carcinoma. PATIENTS AND METHODS: Between January 1989 and April 1995, 148 consecutive patients with locally advanced breast carcinoma participated in the study. Of these, 140 fully evaluable patients (67, stage IIIA; 73, stage IIIB) were treated with three courses of 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC), followed by modified radical mastectomy when technically feasible or definitive radiation therapy. The median age was 53 years (range, 26 to 75 years); 55% of patients were postmenopausal. RESULTS: Objective response was recorded in 99 of 140 patients (71%; 95% confidence interval, 63% to 79%). Complete response occurred in 11 patients (8%), and partial response occurred in 88 patients (63%). No change was recorded in 37 patients (26%), and progressive disease occurred in 4 patients (3%). One hundred and thirty-six patients underwent the planned surgery. Maximal pathological response of the primary tumor (in situ carcinoma or minimal microscopic residual tumor) was observed in 24 (18%); 112 patients (82%) presented minimal pathological response of the primary tumor (gross residual tumor). The number of metastatic axillary nodes after neoadjuvant chemotherapy was as follows: N0, 39 patients (29%); N1-N3, 35 patients (26%); > N3, 62 patients (45%). Considering the initial TNM status, 75% of the patients had decreases in tumor compartment after neoadjuvant chemotherapy. Also, 31% and 23% of patients with clinical N1 and N2, respectively, showed uninvolved axillary lymph nodes. A significant correlation was noted between pathological response of primary tumor and the number of metastatic axillary lymph nodes. Median disease-free survival was 34 months, whereas median overall survival was 66 months. Pathological responses of both primary tumor and metastatic axillary lymph nodes were strongly correlated with disease-free survival and overall survival in univariate analyses. Additionally, in a proportional hazard regression model and in an accelerated failure time model, metastatic axillary lymph nodes significantly influenced both disease-free survival and overall survival, whereas pathological response of primary tumor did so on disease-free survival only. CONCLUSION: After neoadjuvant chemotherapy, pathological responses of both primary tumor and metastatic axillary lymph nodes had a marked prognostic significance and influenced outcome for patients with locally advanced breast carcinoma. Our results suggest that maximal tumor shrinkage and sterilization of potentially involved axillary nodes may represent a major goal of neoadjuvant chemotherapy. Further studies are warranted to clarify whether these results reflect the therapeutic effect or intrinsic biologic factors of the tumor.

Double modulation of 5-fluorouracil by methotrexate and high-dose L-leucovorin in advanced colorectal cancer.

A phase II trial was performed to evaluate the efficacy and toxicity of a double modulation of 5-fluorouracil (5-FU) by methotrexate (MTX) and L-leucovorin (L-LV) in patients with advanced recurrent (inoperable) or metastatic colorectal carcinoma (ACC). Between July 1993 and October 1995, 41 patients with ACC received a regimen that consisted of MTX 150 mg/m2 i.v., infused over a 20-minute period at hour 0, followed 19 hours later by L-LV 250 mg/m2 in a 2-hour i.v. infusion. 5-FU, 900 mg/m2, was administered by i.v. push injection at hour 20. Beginning 24 hours after MTX administration, all patients received four doses of L-LV, 15 mg/m2 i.m., every 6 hours. Cycles were repeated every 15 days. Two patients were not assessable for response. Objective regression was observed in 11 of 39 (28%) patients, [95% confidence interval (CI), 14-42%]. One (2%) patient achieved complete response (CR) and 10 (26%) partial response (PR). No change was recorded in 15 (39%) patients and progressive disease was noted in 13 (33%) patients. The median time to treatment failure was 6 months and the median survival time was 10 months. Toxicity was within acceptable limits, but one therapy-related death due to severe leukopenia was observed. The dose-limiting toxicity was mucositis. Eight episodes of grade 3 or 4 stomatitis were observed, and were responsible for dosage modifications of MTX and 5-FU. In conclusion, further in experimental and clinical studies are clearly necessary in order to design the best modulatory strategy of 5-FU.

[Considerations on interdisciplinarity: theory and practice]. / Consideraciones en Torno a la Interdisciplinariedad: Teoría y Práctica.

The curricular content of undergraduate programs in the health sciences should integrate, in a logical and coherent manner, competencies in general education as well as professional and interdisciplinary competencies. Among the principal obstacles for integration discussed are inflexibility of administrative and accreditation policies and lack of an interdisciplinary vision in curriculum development. This article examines the need to prepare a graduate with competencies to attend patient/client as a holistic human being, thus requiring to make use of psychological, ethical, legal & philosophical knowledge as well as concepts, skill and attitudes of the profession. The program of Bachelor in Health Sciences of the College of Health Related Professions is presented as one of an interdisciplinary nature, in which 23 percent of the total credits are general education courses, 49 percent are professional courses, 17 percent are interdisciplinary courses and 11 percent are elective courses.

Estudio clínico terapéutico de la constipación con grageas de senósidos / Therapeutical clinical study of constipation with sennoside granules

La constipación es un problema que afecta a un número creciente de personas. Su causa obedece a diversos factores psicológicos, entre otros. En este estudio se utilizó un extracto estandarizado de Sen el cual pertenece al grupo de antiquinonas que actúan por contacto modificando la absorción de agua y electrolitos en el intestino grueso. Se seleccionaron 21 pacientes, 17 del sexo femenino y cuatro del masculino. Las edades fluctuaron entre 19 y 85 años con una media de 38. El tiempo de evolución de la constipación en meses fue de 3-80 con una media de 33. A todos los pacientes se les efectuaron exámenes de laboratorio antes y después de la prueba, y colon por enema. Los pacientes se agruparon de acuerdo a la respuesta al tratamiento. La mayoría de los pacientes (81 por ciento) respondieron con rapidez al tratamiento con una sola gragea del extracto estandarizado de Sen, y en promedio se requirió menos de una gragea al día durante el periodo de observación que due de 28 días para asegurar un ritmo de defecación normal. No se reportaron reacciones secundarias y en ningún caso hubo necesidad de suspender el medicamento. Se concluye que el extracto estandarizado de Sen es seguro, eficaz y bien tolerado en el tratamiento de la constipación crónica.

[Spinal electrical stimulation. Current indications and results in a series of 46 patients]. / Estimulación eléctrica medular. Indicaciones actuales y resultados en una serie de 46 pacientes.

We report the clinical results observed in a series of 46 patients with chronic pain who underwent spinal cord electrical stimulation. Candidates were selected according to previous clinical criteria and they were followed-up during a period of 5 to 27 months. Fifteen patients had a residual backache after surgery of the lumbar spine, 19 patients complained angina pectoris, 5 patients peripheral vasculopathies, and 7 subjects had different types of neurogenic pain. A total of 5 patients failed to complete the trial period of 7 to 10 days. Among the 34 patients who continued to use the medullar stimulation, good results were obtained in 75% of cases of backache , 100% of patients with angina and vasculopathies, and 50% of patients with neurogenic pain. There were no relevant complications. We conclude that the results of spinal cord stimulation can be improved by using more strict indications, by performing a previous test period before definitive implantation, and by achieving a large technical experience.

Stress-induced gastroduodenal lesions and total parenteral nutrition in critically ill patients: frequency, complications, and the value of prophylactic treatment. A prospective, randomized study.

OBJECTIVE: To assess the frequency, complications, and value of prophylactic treatment of stress-induced gastroduodenal lesions. DESIGNS: Patients were prospectively randomized to treatment with total parenteral nutrition, either alone, with sucralfate, or with ranitidine. SETTING: A multidisciplinary ICU from a tertiary care referral center. PATIENTS: Ninety-seven patients submitted to prolonged mechanical ventilation, with normal hepatic and renal function, in metabolic stress, and receiving total parenteral nutrition. INTERVENTIONS: On admission, we determined the Acute Physiology and Chronic Health Evaluation II score and the catabolic index score. We also performed an endoscopic examination on day 3, every 7 days subsequently, and whenever needed. Thirty patients received total parenteral nutrition alone. Twenty-four patients received total parenteral nutrition and sucralfate (1 g by nasogastric tube every 4 hrs). Nineteen patients received total parenteral nutrition and ranitidine (50 mg iv every 6 hrs). MAIN RESULTS: The overall occurrence rate of gastroduodenal mucosal damage was 29.6%. The overall frequency rate for stress ulcerations was 15.6% and was 6.2% for stress hemorrhage. There were no deaths secondary to stress hemorrhage. The difference in the frequency of stress-induced mucosal lesions and stress hemorrhage between the studied groups was not statistically significant. CONCLUSIONS: Additional prophylaxis to total parenteral nutrition in the form of sucralfate and ranitidine to prevent acute upper gastrointestinal bleeding is not required in this group of ICU patients.