[History and challenges of clinical simulation in the learning of procedural skills by nursing students]. / El rol de la simulación en el aprendizaje de habilidades procedimentales en estudiantes de enfermería: historia y desafíos.

Procedural skills are essential in the nursing profession and should be acquired during undergraduate training according to new regulations. Clinical simulation is a good alternative to teach such skills. During COVID pandemic, face-to-face learning activities were reduced to a minimum amount, thus hampering the use of clinical simulations. Since simulations should adapt to the new scenario, their virtual implementation appears as an alternative. The latter should become an important teaching tool while restrictions in mobility last. We herein review the evolution of clinical simulation as a teaching tool and to determine its future challenges.

Direct visualization of the native structure of viroid RNAs at single-molecule resolution by atomic force microscopy.

Viroids are small infectious, non-protein-coding circular RNAs that replicate independently and, in some cases, incite diseases in plants. They are classified into two families: Pospiviroidae, composed of species that have a central conserved region (CCR) and replicate in the cell nucleus, and Avsunviroidae, containing species that lack a CCR and whose multimeric replicative intermediates of either polarity generated in plastids self-cleave through hammerhead ribozymes. The compact, rod-like or branched, secondary structures of viroid RNAs have been predicted by RNA folding algorithms and further examined using different in vitro and in vivo experimental techniques. However, direct data about their native tertiary structure remain scarce. Here we have applied atomic force microscopy (AFM) to image at single-molecule resolution different variant RNAs of three representative viroids: potato spindle tuber viroid (PSTVd, family Pospiviroidae), peach latent mosaic viroid and eggplant latent viroid (PLMVd and ELVd, family Avsunviroidae). Our results provide a direct visualization of their native, three-dimensional conformations at 0 and 4 mM Mg2+ and highlight the role that some elements of tertiary structure play in their stabilization. The AFM images show that addition of 4 mM Mg2+ to the folding buffer results in a size contraction in PSTVd and ELVd, as well as in PLMVd when the kissing-loop interaction that stabilizes its 3D structure is preserved.

Análisis epidemiológico del programa de vigilancia activa de Piscirickettsia salmonis del Servicio Nacional de Pesca y Acuicultura de Chile.

Piscirickettsia salmonis is the causative agent of piscirickettsiosis, a disease that causes significant economic losses in salmonid sea farms in Chile. The objective of this study was to determine and describe the geographical distribution, seasonality and time period when P. salmonis was first detected in farms studied under the active surveillance programme for piscirickettsiosis of the National Fisheries and Aquaculture Service of Chile (SERNAPESCA), which was conducted from January 2013 to March 2017. A 0.28% prevalence of piscirickettsiosis was determined in freshwater fish and one of 58.1% in sea farms. The prevalence of P. salmonis was 61.1% in the Aysén region, 59.8% in the Los Lagos region, 5.1% in the Los Ríos region and 3.0% in the Magallanes region. In Los Lagos and Aysén, eight clusters of sea farms were identified, in space and time, as having a positive diagnosis of P. salmonis, whereas, in Magallanes, none was identified, confirming the absence of horizontal transmission or spread of the agent in this geographical area. A seasonal variation was found in the monthly prevalence of P. salmonis, with increases in Salmo salar and Oncorhynchus mykiss in summer and autumn, and in Oncorhynchus kisutch in winter, spring and summer. It was determined that the average time required to detect the agent after fish had been transferred to the sea was 105 days (minimum, 7 days; maximum, 351 days), and no differences were found either between regions or species. Thus the results obtained from the active surveillance programme have helped to increase knowledge of the epidemiology of P. salmonis.

Piscirickettsia salmonis est l'agent étiologique de la piscirickettsiose, une maladie à l'origine de lourdes pertes économiques pour la filière de la salmoniculture marine du Chili. Les auteurs présentent les résultats d'une étude visant à déterminer et à décrire la distribution géographique, les variations saisonnières et le moment où P. salmonis est détectée pour la première fois dans les fermes salmonicoles couvertes par le programme de surveillance active de la piscirickettsiose mis en oeuvre par le Service national de la pêche et de l'aquaculture (Sernapesca) du Chili de janvier 2013 à mars 2017. Les taux de prévalence de la piscirickettsiose étaient de 0,28 % chez les poissons d'eau douce et de 58,1% dans les sites marins. Au niveau des régions, le taux de prévalence de P. salmonis était de 61,1 % à Aysén, de 59,8 % à Los Lagos, de 5,1 % à Los Ríos et de 3,0 % à Magallanes. À Los Lagos et à Aysén huit groupements de fermes salmonicoles marines ont été identifiés dans l'espace et le temps comme ayant été infectés par l'agent pathogène, tandis qu'à Magallanes aucune détection n'a eu lieu, ce qui confirme l'absence de transmission horizontale et de dissémination de l'agent pathogène dans cette zone géographique. La prévalence mensuelle de P. salmonis fait ressortir une variation saisonnière, avec une prévalence accrue en été et en automne chez Salmo salar et Oncorhynchus mykiss, et en hiver, au printemps et en été chez O. kisutch. Il a été établi que le laps de temps nécessaire pour détecter l'agent pathogène après le transfert en mer des poissons était de 105 jours en moyenne (minimum 7 jours, maximum 351 jours), moyenne non affectée par la région ou l'espèce. Ces résultats ont donc permis de mieux appréhender l'épidémiologie de l'agent pathogène grâce au programme de surveillance active.

Piscirickettsia salmonis es el agente causal de la piscirickettsiosis, enfermedad que causa importantes pérdidas económicas en los centros marinos de cultivos de salmónidos de Chile. Este estudio tuvo como objetivo determinar y describir la distribución geográfica, la estacionalidad y momento de la primera detección de P. salmonis en los centros de cultivo estudiados en el programa de vigilancia activa de la piscirickettsiosis del Servicio Nacional de Pesca y Acuicultura (Sernapesca) de Chile, que se llevó a cabo entre enero de 2013 y marzo de 2017. Se determinó una prevalencia de piscicrickettsiosis del 0,28% en peces de agua dulce y del 58,1% en centros marinos. En la región de Aysén, la prevalencia de P. salmonis fue del 61,1%, en Los Lagos, del 59,8%, en Los Ríos, del 5,1%, y en Magallanes, del 3,0%. En Los Lagos y Aysén, se identificaron ocho conglomerados de centros marinos, en el espacio y en el tiempo, con diagnóstico positivo del agente, en cambio, en Magallanes no se detectó, lo cual confirma la inexistencia de transmisión horizontal y de diseminación del agente en esta área geográfica. Se observó una variación estacional en la prevalencia mensual de P. salmonis, en la cual se comprueba un alza en verano y otoño en el caso de Salmo salar y Oncorhynchus mykiss, y en invierno, primavera y verano en el caso de O. kisutch. Se determinó que la media de tiempo necesario para la detección del agente desde la transferencia de los peces al mar era de 105 días (mínimo, 7; máximo, 351 días), y no se observaron diferencias entre regiones o especies. Así los resultados contribuyen a conocer la epidemiología del agente a través del programa de vigilancia activa.

Clinical usefulness of prognostic biomarkers in optic neuritis.

BACKGROUND AND PURPOSE: Different biological and radiological biomarkers predict clinical conversion to multiple sclerosis (MS) after a clinically isolated syndrome (CIS). The aim was to explore their role in predicting the outcome of patients with optic neuritis (ON), a CIS considered to have a benign prognosis. METHODS: Sixty-eight consecutive ON patients were followed prospectively. Magnetic resonance imaging (MRI) and cerebrospinal fluid studies including oligoclonal immunoglobulin G (IgG) bands (OCGBs), lipid-specific oligoclonal IgM bands (LS-OCMBs) and neurofilament light chain quantification were performed at disease onset. Conversion to clinically definite MS (CDMS) was monitored. RESULTS: The mean time of follow-up of our series was 46.4 months. Twenty-five patients (36.7%) developed CDMS during follow-up. Neurofilament light chain levels did not predict clinical conversion. By contrast, an abnormal MRI increased the risk of CDMS [hazard ratio (HR) 12.5, P = 0.013]. The clearest association was found in patients with more than three T2 lesions. OCGBs also predicted the onset of CDMS (HR 21.3, P = 0.003) and LS-OCMBs were associated with a shorter time to CDMS (HR = 116.6, P < 0.001). CONCLUSIONS: Magnetic resonance imaging and OCGBs predicted conversion to CDMS after an ON episode. In addition, LS-OCMBs identified the ON patients more likely to develop MS early. These results, applicable to the everyday clinical setting, may be of interest for therapeutic decisions.

Evidence and molecular characterization of Bartonella spp. and hemoplasmas in neotropical bats in Brazil.

The order Chiroptera is considered the second largest group of mammals in the world, hosting important zoonotic virus and bacteria. Bartonella and hemotropic mycoplasmas are bacteria that parasite different mammals' species, including humans, causing different clinical manifestations. The present work aimed investigating the occurrence and assessing the phylogenetic positioning of Bartonella spp. and Mycoplasma spp. in neotropical bats sampled from Brazil. Between December 2015 and April 2016, 325 blood and/or tissues samples were collected from 162 bats comprising 19 different species sampled in five states of Brazil. Out of 322 bat samples collected, while 17 (5·28%) were positive to quantitative PCR for Bartonella spp. based on nuoG gene, 45 samples (13·97%) were positive to cPCR assays for hemoplasmas based on 16S rRNA gene. While seven sequences were obtained for Bartonella (nuoG) (n = 3), gltA (n = 2), rpoB (n = 1), ftsZ (n = 1), five 16S rRNA sequences were obtained for hemoplasmas. In the phylogenetic analysis, the Bartonella sequences clustered with Bartonella genotypes detected in bats sampled in Latin America countries. All five hemoplasmas sequences clustered together as a monophyletic group by Maximum Likelihood and Bayesian Inference analyses. The present work showed the first evidence of circulation of Bartonella spp. and hemoplasmas among bats in Brazil.

Drifts in real-time partial wavefront correction and how to avoid them.

In visual experiments that require real-time partial correction of wavefront aberrations, small errors occur that accumulate over time and lead to drifts in Zernike coefficients of the uncorrected aberrations. A simple algorithm that does not require the inclusion of an additional optical path to obtain independent measurements of the eye's aberrations is described here, and its effectiveness in preventing these drifts is demonstrated.

The challenge of improving boiling: lessons learned from a randomized controlled trial of water pasteurization and safe storage in Peru.

Boiling is the most common method of household water treatment in developing countries; however, it is not always effectively practised. We conducted a randomized controlled trial among 210 households to assess the effectiveness of water pasteurization and safe-storage interventions in reducing Escherichia coli contamination of household drinking water in a water-boiling population in rural Peru. Households were randomized to receive either a safe-storage container or a safe-storage container plus water pasteurization indicator or to a control group. During a 13-week follow-up period, households that received a safe-storage container and water pasteurization indicator did not have a significantly different prevalence of stored drinking-water contamination relative to the control group [prevalence ratio (PR) 1·18, 95% confidence interval (CI) 0·92-1·52]. Similarly, receipt of a safe-storage container alone had no effect on prevalence of contamination (PR 1·02, 95% CI 0·79-1·31). Although use of water pasteurization indicators and locally available storage containers did not increase the safety of household drinking water in this study, future research could illuminate factors that facilitate the effective use of these interventions to improve water quality and reduce the risk of waterborne disease in populations that boil drinking water.

[Perceptions about the elisa test of people diagnosed at the aids stage]. / Percepción de la vivencia del acceso oportuno al diagnóstico del VIH, en personas viviendo con VIH/SIDA: Acceso oportuno al test de VIH.

BACKGROUND: The delay in the diagnosis of AIDS results in higher treatment costs. AIM: To reveal the experiences of people who were diagnosed in the AIDS stage about the access to the ELISA test. MATERIAL AND METHODS: In depth interviews were carried out to 15 participants from public hospitals who were in the AIDS stage at the moment of the diagnosis. The main questions asked were about the motivations to take the test, the barriers found and the help received from the health care personnel. All interviews were recorded and analyzed according to Kripperdorff. RESULTS: The three categories that emerged were the motivations to take the test, the facilitators found and the difficulties to access to the test. The main motivation was a condition of vulnerability due to the suspicion or certainty of being infected. The main facilitator was the sensation of being accepted and not discriminated. The main difficulties were the fear of having a positive test and of being discriminated and the lack of information. CONCLUSIONS: Knowing these experiences will help to improve the early detection of HIV infections.

Can 3D power Doppler identify levator ani vascularization at its pubic insertion?

INTRODUCTION AND HYPOTHESIS: The levator ani is the most important muscle in the pelvic floor. This pilot study using 3D power Doppler aimed to identify normal vascularization of the puborectalis/pubovisceralis muscle at its insertion in nulliparous and premenopausal women. METHODS: Forty nulliparous and premenopausal women were evaluated at the Gynecological Unit of a tertiary hospital. All women underwent a translabial ultrasound (US) with 3D power Doppler. Pubic insertion of the puborectalis/pubovisceralis muscle was assessed in the axial plane, and vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) were calculated bilaterally. Volumes were analyzed offline by two independent observers, and interobserver agreement and correlation between variables was calculated. RESULTS: A high, statistically significant, correlation was found between the three US indices on each side (p < 0.005). No correlation was found between the US index and either of the demographic parameters of body mass index [(BMI), p > 0.241], or age (p > 0.398). The degree of correlation between the same index on the different sides was not statistically significant. CONCLUSION: Puborectalis/pubovisceralis muscle vascularization at its insertion can be identified using 3D Doppler US, but values differ substantially from those of the contralateral side.

Analysis of risk factors for hydrocephalus development in newborn infants with germinal matrix hemorrhage.

AIM: The aim of this study was to analyze risk factors for the development of hydrocephalus in newborn infants with germinal matrix (GM) hemorrhage. METHODS: The study comprised 271 patients admitted to Carlos Haya University Hospital in Malaga with GM hemorrhage. The following data were recorded: gestational age, gender, twin birth, head circumference at birth, weight at birth, and Papile grade. Severe obstetrical (abruption, chorioamnionitis, pregnancy-induced hypertension, tocolytic treatment) and neonatal disorders (respiratory distress syndrome, neonatal infection, coagulation disorder, patent ductus arteriosus, necrotizing enterocolitis) were also recorded. Symptomatic hydrocephalus was diagnosed in the event of a progressive increase in head circumference and ventricular indices requiring shunting. RESULTS: Of the 271 patients, 139 (51%) developed posthemorrhagic ventriculomegaly; 47 patients (17%) developed symptomatic hydrocephalus and needed shunt implantation. We found a significant relationship between the development of symptomatic hydrocephalus and Papile grade, lower gestational age, lower birth weight, twin birth, and neonatal infection. CONCLUSION: Awareness of risk factors for the development of hydrocephalus in newborn infants with GM hemorrhage should be emphasized in order to enable an early diagnosis of ventriculomegaly and symptomatic hydrocephalus and thus make a correct therapeutic decision.

Ventriculoperitoneal shunt as a primary neurosurgical procedure in newborn posthemorrhagic hydrocephalus: report of a series of 47 shunted patients.

PURPOSE: Intraventricular hemorrhage is the most common cause of infantile acquired hydrocephalus. Our objective is to determine if the implantation of ventriculoperitoneal shunt in posthemorrhagic hydrocephalus as a primary and definitive neurosurgical treatment, with no previous temporary procedures, would decrease complication rates with good functional outcomes. METHODS: Two hundred seventy-one patients with germinal matrix hemorrhage were diagnosed at the Carlos Haya Hospital between 2003 and 2010. Forty-seven patients underwent ventriculoperitoneal shunt after developing symptomatic hydrocephalus. The minimum weight required for shunt implantation was 1,500 g. We recorded complications related to the surgical procedure and analyzed functional state with a self-developed four-grade scale. RESULTS: One hundred thirty-nine (51.3 %) patients with intraventricular hemorrhage developed ventricular dilatation, but only 47 patients (17.34 %) needed shunting. In seven cases, temporary neurosurgical procedures were performed, but in all of them, this was followed by ventriculoperitoneal shunt implantation. The infection rate was 4.25 %, and shunt obstruction rate was 4.25 %. More than 80 % of patients were classified as good or excellent functional state. Mean follow-up period was 38.75 months (SD, 27.09; range, 1-102 months). CONCLUSIONS: Ventriculoperitoneal shunting as a primary neurosurgical treatment in posthemorrhagic hydrocephalus would decrease surgical morbidity with good functional outcome.

Evaluating the success of vegetation restoration in rewilded salt marshes.

Floodbank realignment is a common practice aimed at restoring salt marsh vegetation on previously embanked land. However, experiences indicate that it may take several years before salt marsh vegetation becomes fully established. Various challenges arising from ecogeomorphic feedback mechanisms could pose significant setbacks to vegetation recolonization. The widespread adoption of transplantation techniques for the restoration and rehabilitation of rewilded landscapes has indeed proven to be a valuable tool for accelerating plant development. In the Ria Formosa coastal lagoon (South of Portugal), a pilot plan was implemented, and two salt marsh pioneer species, Spartina maritima (syn. Sporobolus maritimus) and Sarcocornia perennis (syn. Salicornia perennis), were transplanted from a natural salt marsh to a rewilded marsh. Biodegradable 3D porous structures were installed to mimic transplant clumping, aid sedimentation, and enhance the plant's initial adjustment. Ecological, sediment, and hydrodynamic data were collected during the 12-month pilot restoration plan. The environmental profiles of the donor and restoration sites were compared to substantiate the success of the transplants in the rewilded salt marsh. Results show that although plant shoot density decreased after the transplanting, Spartina maritima acclimated well to the new environmental conditions of the restoration site, showing signs of growth and cover increase, whilst Sarcocornia perennis was not able to acclimatize and survive in the restoration site. The failure behind the Sarcocornia perennis acclimation might be related to the bed properties and topographic properties of the restoration site in the rewilded marsh. Major findings contribute to a more comprehensive understanding of how salt marsh pioneering vegetation successfully colonizes disturbed habitats, facilitated using 3D-biodegradable structures.

[Translated article] Unplanned excision of soft tissue sarcomas of the musculoskeletal system.

INTRODUCTION: The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions ("whoops" surgeries). This study evaluates the frequency of these type of procedures, trying to identify patient characteristics, tumours, surgical treatment and final results. MATERIAL AND METHODS: 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with Chi2 tests and a Cox multivariate regression model. RESULTS: Unplanned excisions of SPBAL have taken place in 18% of the patients in our area, mainly in tumours of less than 5cm and located superficial to the fascia. 29.2% of these patients did not have a previous imaging test. It has not been shown that a "whoops" surgery can lead to a decrease in survival or a higher rate of recurrences. CONCLUSIONS: We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumour, as well as adherence to the referral guidelines to reference centres.

Unplanned excision of soft tissue sarcomas of the musculoskeletal system. / Resección no planificada en sarcomas de partes blandas del aparato locomotor.

INTRODUCTION: The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions ("whoops" surgeries). This study evaluates the frequency of these type of procedures, trying to indentify patient characteristics, tumors, surgical treatment and final results. MATERIAL AND METHODS: 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with chi2 tests and a Cox multivariate regression model. RESULTS: Unplanned excisions of SPBAL have taken place in 18% of the patients in our área, mainly in tumors of less than 5 cm and located superficial to the fascia. 29,2% of these patients did not have a previous imaging test. It has not been shown that a "whoops" surgery can lead to a decrease in survival or a higher rate of recurrences. CONCLUSIONS: We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumor, as well as adherence to the referral guidelines to reference centers.

Mutation screening of AURKB and SYCP3 in patients with reproductive problems.

Mutations in the spindle checkpoint genes can cause improper chromosome segregations and aneuploidies, which in turn may lead to reproductive problems. Two of the proteins involved in this checkpoint are Aurora kinase B (AURKB), preventing the anaphase whenever microtubule-kinetochore attachments are not the proper ones during metaphase; and synaptonemal complex protein 3 (SYCP3), which is essential for the formation of the complex and for the recombination of the homologous chromosomes. This study has attempted to clarify the possible involvement of both proteins in the reproductive problems of patients with chromosomal instability. In order to do this, we have performed a screening for genetic variants in AURKB and SYCP3 among these patients using Sanger sequencing. Only one apparently non-pathogenic deletion was found in SYCP3. On the other hand, we found six sequence variations in AURKB. The consequences of these changes on the protein were studied in silico using different bioinformatic tools. In addition, the frequency of three of the variations was studied using a high-resolution melting approach. The absence of these three variants in control samples and their position in the AURKB gene suggests their possible involvement in the patients' chromosomal instability. Interestingly, two of the identified changes in AURKB were found in each member of a couple with antecedents of spontaneous pregnancy loss, a fetal anencephaly and a deaf daughter. One of these changes is described here for the first time. Although further studies are necessary, our results are encouraging enough to propose the analysis of AURKB in couples with reproductive problems.

Solar photo-Fenton mineralization of antipyrine in aqueous solution.

The mineralization of an aqueous solution of antipyrine (C11H12N2O), an emerging contaminant, using a solar photocatalytic oxidation process assisted with ferrioxalate was evaluated in a compound parabolic collector (CPC) pilot plant. Under the selected operating conditions ([H2O2] = 250 ppm, [Fe] = 14 ppm, pH = 2.7, and [(COOH)2·2H2O] = 80 ppm), 60% of TOC is removed just 5 min after treating an aqueous solution containing 50 ppm of antipyrine. The addition of oxalic acid up to a maximum concentration of 80 ppm significantly increases the mineralization rate during the first 15 min of the reaction. The synergism between the solar and dark H2O2/ferrioxalate process was quantified at 79%, calculated from the pseudo first-order mineralization rate constants. The operational costs due to the consumption of electrical energy, reagents and catalysts were calculated from the optimal conditions and compared with a novel sono-photocatalytic process using artificial UV-light. The results showed that the ferrioxalate-assisted solar photo-Fenton process was economically feasible, being able to achieve up to 60% mineralization with a total cost of 4.5 cent €/g TOC removed (1.1 €/m(3)).

[Identification of educational needs among patients with HIV and their health care providers]. / Necesidades educativas de un grupo de personas viviendo con VIH: diagnóstico basado en la perspectiva de los usuarios y de los profesionales que los atienden.

BACKGROUND: The success of educational interventions depends on the integration of educational programs into clinical practice. AIM: To determine the educational needs and perceived barriers of people living with HIV (PHIV) and their health care providers (HCP). MATERIAL AND METHODS: Qualitative study conducted in 60 PHIV and 10 HCP. For data collection, a semi-structured in-depth interview was applied, addressing the educational needs (content, methodology, person, time, physical location) and identified barriers to implement an educational program for PHIV Content analysis technique was used for data analysis. RESULTS: PHIV and their HCP identified the same educational needs as the following: general-related content, psychological, sexual and secondary prevention aspects of the disease. Individual sessions with written material and web pages were identified as important resources to support education. Both PHIV and professionals expressed their willingness to participate in educational programs, but the most commonly identified barrier was lack of time. CONCLUSIONS: This study identifies the key elements to include in an educational program for Chilean PHIV from the user and professional perspective.

Short-term sedimentation dynamics in mesotidal marshes.

One of the key questions about wetlands resilience to sea-level rise is whether sediment supply will be enough to keep them coping with growing inundation levels. To address this question, researchers have put a lot of effort into field data collection and ecogeomorphic modelling, in an attempt to identify the tipping points of marsh survival. This study uses fieldwork data to characterize the sediment fluxes between the tidal flats and salt marshes, in the Ria Formosa lagoon (Portugal). Sediment fluxes were measured from the tidal channel towards the mid-upper marsh, during neap and spring tide conditions. The flow magnitude was measured, and induced transport was determined based on shear velocities. Deposition rates, instantaneous suspended sediment and near-bed velocities were linked through theoretical formulas and used to characterize time-averaged conditions for sediment delivery and deposition to the site. The results showed that suspended sediment concentrations and sediment deposition varied across the transect with no specific relation to elevation. Maximum water depths were recorded in the vegetated tidal flat, and the maximum currents were flood dominated, in the order of 0.20 m/s, in the low marsh due to flow-plant interactions and an increase of turbulence. Deposition rates ranged between 20 to 45 g/m2/hr, after a complete tidal cycle, and were higher in the mid-upper marsh. Hydroperiod was not the main contributor to sediment deposition in the study area. Sediment transport was tidally driven, strongly two-dimension during the cycle, and highly influenced by the vegetation. Measurements of marsh sediment flux obtained in our work are diverse from the ones found in the literature and evidence the importance of considering spatio-temporal variability of vegetated platforms in assessing overall marsh bed level changes.

Flow cytometric analysis of duodenal intraepithelial lymphocytes (celiac lymphogram): A diagnostic test for celiac disease.

Celiac disease (CD) diagnosis in adults and certain cases of children mainly relies on the assessment of histopathological features in duodenal biopsies. However, none of the histological findings that characterize CD are pathognomonic. This, in addition to the clinical heterogeneity of the disease and the presence of seronegative forms, makes the diagnosis of CD still a challenge. A hallmark of the celiac mucosa is the elevated number of TCRγδ intraepithelial lymphocytes (IEL) in the epithelium, which may remain increased even long after gluten withdrawal. Active disease is also characterized by the decreased CD3- IEL subset. The use of flow cytometry enables a precise cell counting and phenotyping, allowing the ascertainment of both TCRγδ+ and CD3- IEL subsets, what is known as the "IEL lymphogram." Although determination of this lymphogram has become a routine evaluation tool in numerous hospitals, standardization of the technical method will guarantee an accurate performance in order to become a pivotal technique for CD diagnosis. Here we describe the protocol to process duodenal biopsies in order to obtain the IELs from the mucosa and to characterize lymphocyte populations by flow cytometry to obtain the IEL lymphogram.

Recurrent cerebellar ischemic infarctions and stereotyped peri-ictal sympathetic responses in a near-SUDEP patient with cardiovascular risk factors.

We report a 60-year-old woman who presented to the emergency department after experiencing a witnessed unknown onset bilateral tonic clonic seizure (GTCS) that culminated in cardiac arrest. A neurology consultant uncovered a years-long history of frequent episodic staring followed by confusion and expressive aphasia, which strongly suggested that she suffered from epilepsy. Thus, her cardiac arrest and subsequent resuscitation met criteria for a near-sudden unexpected death in epilepsy (SUDEP) diagnosis. Serial bloodwork demonstrated transient troponin I elevations and leukocytoses, while a brain MRI revealed global cerebral anoxic injury and a small acute right cerebellar ischemic infarction. A review of her medical record uncovered a hospitalization sixteen months earlier for a likely GTCS whose workup showed similar troponin I elevations and leukocytoses, and surprisingly, a different small acute right cerebellar ischemic infarction in the same vascular territory. To our knowledge, this is the first report of subcortical ischemic infarctions occurring concurrently with GTCSs in a near-SUDEP patient. Aside from illustrating the key role of inpatient neurologists in the diagnosis of near-SUDEP, this manuscript discusses the potential significance of postictal ischemic infarctions, transient asymptomatic troponin elevations, and transient non-infectious leukocytoses in epilepsy patients with cardiovascular risk factors.