Paediatric stroke in the northern Spanish region of Aragon: incidence, clinical characteristics, and outcomes.

BACKGROUND: Recent years have seen considerable changes in the prevention and treatment of acute ischaemic stroke in adult patients. However, the low incidence of paediatric stroke makes the development of specific guidelines more challenging. This study aims to clarify the situation of these children in our region in order to establish a regional protocol to improve the care provided to these patients. METHODS: We performed a regional incidence study of pediatric stroke (≤ 15 years of age) in Aragon, Spain (1308728 population, 15% aged ≤ 15 years) between 2008 and 2019. Data were obtained from hospital discharge records, including deaths, from the regional health service of Aragón, according to ICD codes for cerebrovascular disease. We analysed demographic, clinical, diagnostic/therapeutic, and prognostic variables. RESULTS: A total of 21 events were recorded: 8 ischaemic (38.1%) and 13 haemorrhagic strokes (61.9%). The mean age (SD) was 9.3 years (1.0). The sample included 12 boys and nine girls. No statistically significant differences were found between ischaemic and haemorrhagic strokes, except in the chief complaint (language and motor impairment in ischaemic stroke and headache in haemorrhagic stroke). None of the patients with ischaemic stroke received reperfusion therapies. Including the 3 patients who died during hospitalisation, eight patients (42.1%) had modified Rankin Scale scores > 2 at 12 months. Motor deficits were the most common sequela (n=9). CONCLUSION: Though infrequent, paediatric stroke has an important functional impact. In Spain, Madrid was the first region to adapt the existing code stroke care networks for adult patients. In Aragon, this review has enabled us to work closely with the different stakeholders to offer a care plan for acute paediatric ischaemic stroke. Nevertheless, prospective national registries would be valuable to continue improving the care provided to these patients.

Identification of single nucleotide polymorphisms (SNPs) for maize cell wall hydroxycinnamates using a multi-parent advanced generation intercross (MAGIC) population.

Higher hydroxycinnamate content makes maize tissues more recalcitrant to damage by insects, less digestible by ruminants, and less suitable for biofuel production. In a Genome Wide Association Analysis (GWAS) study carried out in a maize MAGIC population, we identified 24 SNPs associated with esterified cell wall-bound hydroxycinnamates, that represented 15 Quantitative Traic Loci (QTL). We identified new genomic regions associated to cell wall bound hydroxycinnamates in maize stover that could have an impact on their content across different genetic backgrounds. The high resolution QTL described in this study could be valuable for addressing positional mapping of genes involved in hydroxycinnamate biosynthesis and could uncover genes implicated in the esterification of hydroxycinnamic acids to the arabinoxylan chains that are poorly understood. However, we found that genetic correlation coefficients between hydroxycinnamate content and economical important traits such as saccharification efficiency, animal digestibility andi pest resistance were low to moderate, so modify specific hydroxycinnamates to indirectly improve cultivar performance will be unsuitable.

Point-of-care ultrasound after attempted suicidal hanging.

Focused cardiac ultrasound (FoCUS) can provide critical information quickly to determine the etiology after cardiac arrest and may expedite a diagnosis in order to identify underlying treatable causes. We present a case of reversible acute left ventricular dysfunction after cardiopulmonary resuscitation following attempted suicide by hanging presenting with severe hypoxemia. FoCUS revealed findings consistent with severe left ventricular dysfunction, and point-of-care ultrasound (PoCUS) ruled out pneumothorax. These findings, in conjunction with the clinical presentation, facilitated an early identification and rapid evaluation of cardiogenic shock; furthermore, they led to the use of FoCUS, which can provide critical information quickly on site for a patient who is suddenly symptomatic after severe mechanical asphyxia in the pediatric emergency department, pediatric intensive care unit, or the prehospital setting.

Association mapping for maize stover yield and saccharification efficiency using a multiparent advanced generation intercross (MAGIC) population.

Cellulosic ethanol derived from fast growing C4 grasses could become an alternative to finite fossil fuels. With the potential to generate a major source of lignocellulosic biomass, maize has gained importance as an outstanding model plant for studying the complex cell wall network and also to optimize crop breeding strategies in bioenergy grasses. A genome-wide association study (GWAS) was conducted using a subset of 408 Recombinant Inbred Lines (RILs) from a Multi-Parent Advanced Generation Intercross (MAGIC) Population in order to identify single nucleotide polymorphisms (SNPs) associated with yield and saccharification efficiency of maize stover. We identified 13 SNPs significantly associated with increased stover yield that corresponded to 13 QTL, and 2 SNPs significantly associated with improved saccharification efficiency, that could be clustered into 2 QTL. We have pointed out the most interesting SNPs to be implemented in breeding programs based on results from analyses of averaged and yearly data. Association mapping in this MAGIC population highlight genomic regions directly linked to traits that influence the final use of maize. Markers linked to these QTL could be used in genomic or marker-assisted selection programs to improve biomass quality for ethanol production. This study opens a possible optimisation path for improving the viability of second-generation biofuels.

Functional assessment of a series of paediatric patients receiving neurointensive treatment: New Functional status scale. / Valoración funcional tras tratamiento neurointensivo pediátrico. Nueva escala de estado funcional (FSS).

INTRODUCTION: Functional health, a reliable parameter of the impact of disease, should be used systematically to assess prognosis in paediatric intensive care units (PICU). Developing scales for the assessment of functional health is therefore essential. The Paediatric Overall and Cerebral Performance Category (POPC, PCPC) scales have traditionally been used in paediatric studies. The new Functional Status Scale (FSS) was designed to provide more objective results. This study aims to confirm the validity of the FSS compared to the classic POPC and PCPC scales, and to evaluate whether it may also be superior to the latter in assessing of neurological function. PATIENTS AND METHOD: We conducted a retrospective descriptive study of 266 children with neurological diseases admitted to intensive care between 2012 and 2014. Functional health at discharge and at one year after discharge was evaluated using the PCPC and POPC scales and the new FSS. RESULTS: Global FSS scores were found to be well correlated with all POPC scores (P<.001), except in category 5 (coma/vegetative state). Global FSS score dispersion increases with POPC category. The neurological versions of both scales show a similar correlation. DISCUSSION: Comparison with classic POPC and PCPC categories suggests that the new FSS scale is a useful method for evaluating functional health in our setting. The dispersion of FSS values underlines the poor accuracy of POPC-PCPC compared to the new FSS scale, which is more disaggregated and objective.

Functional progression of patients with neurological diseases in a tertiary paediatric intensive care unit: Our experience. / Patología neurológica en una unidad de cuidados intensivos pediátricos de tercer nivel. Evolución funcional. Nuestra experiencia.

INTRODUCTION: Neurological diseases explain a considerable proportion of admissions to paediatric intensive care units (PICU), and are a significant cause of morbidity and mortality. This study aims to analyse the functional progression of children with critical neurological conditions. MATERIAL AND METHODS: Retrospective descriptive study of children admitted to PICU with neurological diseases over a period of 3 years (2012-2014), assessing vital and functional prognosis at PICU discharge and at one year according to the Pediatric Cerebral and Overall Performance Category scales (PCPC-POPC) and the Functional Status Scale (FSS). The results are compared with our previous data (1990-1999), and those of the international multicentre PANGEA study. RESULTS: A total of 266 children were studied. The mortality rate was 3%; the PRISM-III and PIM2 models did not show predictive ability. Clinically significant worsening was observed in functional health at discharge in 30% of the sample, according to POPC, 15% according to PCPC, and 5% according to FSS. After one year, functional performance improved according to PCPC-POPC, but not according to FSS. Children with no underlying neurological disease had a higher degree of functional impairment; this was prolonged over time. We observed a decrease in overall and neurocritical mortality compared with our previous data (5.60 vs. 2.1%, P=.0003, and 8.44 vs. 2.63%, P=.0014, respectively). Compared with the PANGEA study, both mortality and cerebral functional impairment in neurocritical children were lower in our study (1.05 vs. 13.32%, P<.0001, and 10.47% vs. 23.79%, P<.0001, respectively). CONCLUSIONS: Nearly one-third of critically ill children have neurological diseases. A significant percentage, mainly children without underlying neurological diseases, had a clinically significant functional impact at PICU discharge and after a year. Neuromonitoring and neuroprotection measures and the evaluation of functional progression are necessary to improve critical child care.

Acute cerebellitis in paediatric patients: Our experience. / Cerebelitis aguda en Pediatría: nuestra experiencia.

INTRODUCTION: Acute cerebellitis is a rare inflammatory disease with a highly variable clinical course that ranges from benign self-limiting symptoms to a fulminant presentation associated with a high risk of death due to compression of the posterior fossa, acute hydrocephalus, and intracranial hypertension. METHODS: We reviewed clinical, laboratory, and radiological findings from children diagnosed with acute cerebellitis between May 2007 and November 2016. We analysed treatments and clinical and radiological progression. RESULTS: Nine children met the diagnostic criteria for cerebellitis. Headache, vomiting, and drowsiness were the most frequent initial symptoms; ataxia, dysarthria, and dysmetria were the most common cerebellar signs. Cerebellitis was diagnosed with magnetic resonance imaging, which revealed cerebellar involvement (unilateral or bilateral); computerised tomography images either were normal or showed indirect signs such as triventricular hydrocephalus due to extrinsic compression of the aqueduct of Sylvius. Corticosteroids were the most commonly used treatment (6 patients). One patient required surgery due to triventricular hydrocephalus. Eight patients recovered completely, whereas the ninth displayed neurological sequelae. CONCLUSIONS: Cerebellitis is a medical and surgical emergency; diagnosis requires a high level of suspicion and an emergency brain magnetic resonance imaging study. It is a clinical-radiological syndrome characterised by acute or subacute encephalopathy with intracranial hypertension and cerebellar syndrome associated with T2-weighted and FLAIR hyperintensities in the cerebellar cortex (unilaterally or bilaterally) and possible triventricular dilatation. Treatment is based on high-dose corticosteroids and may require external ventricular drain placement and decompressive surgery.

Dent and Flint maize diversity panels reveal important genetic potential for increasing biomass production.

KEY MESSAGE: Genetic and phenotypic analysis of two complementary maize panels revealed an important variation for biomass yield. Flowering and biomass QTL were discovered by association mapping in both panels. The high whole plant biomass productivity of maize makes it a potential source of energy in animal feeding and biofuel production. The variability and the genetic determinism of traits related to biomass are poorly known. We analyzed two highly diverse panels of Dent and Flint lines representing complementary heterotic groups for Northern Europe. They were genotyped with the 50 k SNP-array and phenotyped as hybrids (crossed to a tester of the complementary pool) in a western European field trial network for traits related to flowering time, plant height, and biomass. The molecular information revealed to be a powerful tool for discovering different levels of structure and relatedness in both panels. This study revealed important variation and potential genetic progress for biomass production, even at constant precocity. Association mapping was run by combining genotypes and phenotypes in a mixed model with a random polygenic effect. This permitted the detection of significant associations, confirming height and flowering time quantitative trait loci (QTL) found in literature. Biomass yield QTL were detected in both panels but were unstable across the environments. Alternative kinship estimator only based on markers unlinked to the tested SNP increased the number of significant associations by around 40% with a satisfying control of the false positive rate. This study gave insights into the variability and the genetic architectures of biomass-related traits in Flint and Dent lines and suggests important potential of these two pools for breeding high biomass yielding hybrid varieties.

Relationship between time to flowering and stalk and ear damage by second generation corn borers.

In the Mediterranean area, the main corn borer species are Sesamia nonagrioides Lefebvre (Mediterranean corn borer) and Ostrinia nubilalis Hübner (European corn borer). In the overall context of integrated pest control, it is possible to reduce the effect of a pest without having a negative effect on the environment by varying the sowing date. Benefits are possible if the most susceptible stages of the crop no longer coincide with the peak of the pest. We used different cycles of selection (0, 6, 8, 10, and 12) of two populations (Purdue A and Purdue B) of maize selected for early flowering to get a more precise estimation of the relationship between maturity of plant tissues and corn borer damage. We found a relationship between the damage produced by corn borers and the number of days from flowering to infestation. We conclude that, after flowering, a later stage of plant development at the moment of the infestation by corn borers reduces the damage caused by the larvae. Based on our results, we recommend to plant as early as possible so the tissues would be as mature as possible at the moment of insect attack.

Maximizing the reliability of genomic selection by optimizing the calibration set of reference individuals: comparison of methods in two diverse groups of maize inbreds (Zea mays L.).

Genomic selection refers to the use of genotypic information for predicting breeding values of selection candidates. A prediction formula is calibrated with the genotypes and phenotypes of reference individuals constituting the calibration set. The size and the composition of this set are essential parameters affecting the prediction reliabilities. The objective of this study was to maximize reliabilities by optimizing the calibration set. Different criteria based on the diversity or on the prediction error variance (PEV) derived from the realized additive relationship matrix-best linear unbiased predictions model (RA-BLUP) were used to select the reference individuals. For the latter, we considered the mean of the PEV of the contrasts between each selection candidate and the mean of the population (PEVmean) and the mean of the expected reliabilities of the same contrasts (CDmean). These criteria were tested with phenotypic data collected on two diversity panels of maize (Zea mays L.) genotyped with a 50k SNPs array. In the two panels, samples chosen based on CDmean gave higher reliabilities than random samples for various calibration set sizes. CDmean also appeared superior to PEVmean, which can be explained by the fact that it takes into account the reduction of variance due to the relatedness between individuals. Selected samples were close to optimality for a wide range of trait heritabilities, which suggests that the strategy presented here can efficiently sample subsets in panels of inbred lines. A script to optimize reference samples based on CDmean is available on request.

[Retrospective study of risk factors of vertical transmission of hepatitis C virus]. / Estudio retrospectivo de factores de riesgo de transmisión vertical de infección por virus hepatitis C.

INTRODUCTION: Despite the low prevalence of paediatric HCV infection and its initial mild clinical expressiveness, chronic infection could progress into cirrhosis and/or hepatocarcinoma. It is essential to control vertical transmission. Recent studies show that up to 50% of transmissions occur within the uterus. MATERIAL AND METHODS: [corrected] A retrospective study was conducted on 17 cases of (Hepatitis C virus) HCV infection registered over a period of 8 years. Vertical transmission risk factors were analysed, in order to introduce primary prevention. RESULTS: Only parenteral drug addiction significantly increased the rate of HCV transmission; HIV co-infection was not a confounding factor. HCV viremia, HIV co-infection, liver dysfunction and/or duration of the infection did not appear to affect the rate of transmission. Caesarean section, amniocentesis and internal monitoring may be risk factors (not statistically significant), but not prolonged vaginal delivery after amniotic membrane rupture. Breastfeeding showed protection. CONCLUSIONS: The effect of viremia on the risk of transmission is not clearly established, despite the importance usually attributed. Lack of viremia does not discount the risk of transmission, due to viral RNA detection can be intermittent, so it should be interpreted cautiously. Immunosuppression secondary to HIV co-infection implies a higher risk of transmission, but this effect decreases by improving immune competence by antiretroviral treatment. With regard to the birth characteristics, time after the rupture of membranes has not shown being a risk factor; being the caesarean not advisable as a good alternative to finish the pregnancy. Breastfeeding does not increase the risk, even it can be protective. This results would be justified by the low viral content of milk, its inactivation by gastric pH and its immunological benefits. Given that retrospective studies results are limited, prospective studies need to be carried out in order to improve the understanding of the role of possible risk factors and to provide a clear preventive guidelines. At the moment it is essential to control all the children born of mothers with HCV infection.

Comparison of two methods of reciprocal recurrent selection in maize (Zea mays L.).

Reciprocal recurrent selection (RRS) was proposed for simultaneously improving two populations and their cross. A modification of the classical full-sib RRS (FS-RRS) was proposed in which the performance of full-sibs and S(2) families is combined in a selection index (FS-S(2)-RRS). The Mediterranean corn borer (MCB) is the main corn borer species in the Mediterranean and adjacent areas and produces important yield losses. We started two RRS programs (FS-RRS and FS-S(2)-RRS) from the same maize population in which the selection criterion was grain yield under artificial infestation with MCB eggs. Original populations, two cycles of selection derived from them by both RRS methods, and population crosses were evaluated under MCB attack and under insecticide treatment in three different environments. The objective was to compare the efficiency of the FS-RRS and the FS-S(2)-RRS methods for improving grain yield. We found that the FS-S(2)-RRS method was successful for improving the yield of the population cross under optimum conditions (the regression coefficient over cycles was b = 0.87** Mg ha(-1) cycle(-1)) without losing yield under high pressure of MCB attack (b = 0.07). On the contrary, FS-RRS failed to improve the yield of the population cross under optimum conditions (b = 0.65) and tended to decrease the yield under high levels of MCB attack (b = -0.26). We conclude that for developing high yielding and stable varieties, FS-S(2)-RRS is more efficient than the classical FS-RRS method.

A short-form version of the Boston Naming Test for language screening in dementia in a bilingual rural community in Galicia (Spain).

BACKGROUND: Aphasia, one of the core symptoms of cortical dementia, is routinely evaluated using graded naming tests like the Boston Naming Test (BNT). However, the application of this 60-item test is time-consuming and shortened versions have been devised for screening. The hypothesis of this research is that a specifically designed shortened version of the BNT could replace the original 60-item BNT as part of a mini-battery for screening for dementia. The objective of this study was to design a short version of the BNT for a rural population in Galicia (Spain). METHODS: A clinic group of 102 patients including 43 with dementia was recruited along with 78 healthy volunteers. The clinic and control groups were scored on the Spanish version of the Mini-mental State Examination (MMSE) and BNT. In addition, the clinic group was tested with standard neuropsychological instruments and underwent brain investigations and routine neurological examination. BNT items with specificity and sensitivity above 0.5 were selected to compose a short battery of 11 pictures named BNTOu11. ANOVA and mean comparisons were made for MMSE and BNT versions. Receiver operating characteristics (ROC) curves and internal consistency were calculated. RESULTS: Areas under ROC curves (AUC) did not show statistically significant differences; therefore BNTOu11's AUC (0.814) was similar to the 60-item BNT versions (0.785 and 0.779), to the short versions from Argentina (0.772) and Andalusia (0.799) and to the Spanish MMSE (0.866). BNTOu11 had higher internal consistency than the other short versions. CONCLUSIONS: BNTOu11 is a useful and time-saving method as part of a battery for screening for dementia in a psychogeriatric outpatient unit.

Identification of genes related to germination in aged maize seed by screening natural variability.

Ageing reduces vigour and viability in maize inbred lines due to non-heritable degenerative changes. Besides non-heritable genetic changes due to chromosome aberrations and damage in the DNA sequence, heritable changes during maize conservation have been reported. Genetic variability among aged seeds of inbred lines could be used for association studies with seed germination. The objective of this study was to identify genes related to germination in aged seeds. The sweet corn inbred line P39 and the field corn inbred line EP44 were used as plant material. Bulks of living and dead seeds after 20 and 22 years of storage were compared by using simple sequence repeats (SSRs) and, when the bulks differed for a marker, the individual grains were genotyped. Differences between dead and living seeds could be explained by residual variability, spontaneous mutation, or ageing. Variability was larger for chromosome 7 than for other chromosomes, and for distal than for proximal markers, suggesting some relationships between position in the genome and viability in aged seed. Polymorphic SSRs between living and dead seeds were found in six known genes, including pathogenesis-related protein 2, superoxide dismutase 4, catalase 3, opaque endosperm 2, and metallothionein1 that were related to germination, along with golden plant 2. In addition, five novel candidate genes have been identified; three of them could be involved in resistance to diseases, one in detoxification of electrophillic compounds, and another in transcription regulation. Therefore, genetic variability among aged seeds of inbreds was useful for preliminary association analysis to identify candidate genes.