Entomopathogenic Fungus-Related Priming Defense Mechanisms in Cucurbits Impact Spodoptera littoralis (Boisduval) Fitness.

Entomopathogenic fungi (EPF) exhibit direct and indirect mechanisms to increase plant resistance against biotic and abiotic stresses. Plant responses to these stresses are interconnected by common regulators such as ethylene (ET), which is involved in both iron (Fe) deficiency and induced systemic resistance responses. In this work, the roots of cucurbit seedlings were primed with Metarhizium brunneum (EAMa 01/58-Su strain), and relative expression levels of 18 genes related to ethylene (ET), jasmonic acid (JA), and salicylic acid (SA) synthesis, as well as pathogen-related (PR) protein genes, were studied by reverse transcription-quantitative PCR (qRT-PCR). Effects of priming on Spodoptera littoralis were studied by feeding larvae for 15 days with primed and control plants. Genes showed upregulation in studied species; however, the highest relative expression was observed in roots and shoots of plants with Fe deficiency, demonstrating the complexity and the overlapping degree of the regulatory network. EIN2 and EIN3 should be highlighted; both are key genes of the ET transduction pathway that enhanced their expression levels up to eight and four times, respectively, in shoots of primed cucumber. Also, JA and SA synthesis and PR genes showed significant upregulation during the observation period (e.g., the JA gene LOX1 increased 506 times). Survival and fitness of S. littoralis were affected with significant effects on mortality of larvae fed on primed plants versus controls, length of the larval stage, pupal weight, and the percentage of abnormal pupae. These results highlight the role of the EAMa 01/58-Su strain in the induction of resistance, which could be translated into direct benefits for plant development. IMPORTANCE Entomopathogenic fungi are multipurpose microorganisms with direct and indirect effects on insect pests. Also, EPF provide multiple benefits to plants by solubilizing minerals and facilitating nutrient acquisition. A very interesting and novel effect of these fungi is the enhancement of plant defense systems by inducing systematic and acquired resistance. However, little is known about this function. This study sheds light on the molecular mechanisms involved in cucurbits plants' defense activation after being primed by the EPF M. brunneum. Furthermore, the subsequent effects on the fitness of the lepidopteran pest S. littoralis are shown. In this regard, a significant upregulation was recorded for the genes that regulate JA, SA, and ET pathways. This increased expression of defense genes caused lethal and sublethal effects on S. littoralis. This could be considered an added value for the implementation of EPF in integrated pest management programs.

Effect of iron oxide content and microstructural porosity on the performance of ceramic membranes as microbial fuel cell separators.

Ceramic materials based on naturally occurring clays are a low cost and environmentally friendly alternative to commercial polymer-based membranes in bioelectrochemical systems. In this work, ceramic membranes containing different amounts of iron oxide (1.06, 2.76 and 5.75 vol.%) and sintered at different temperatures (1100, 1200 and 1300 °C) have been elaborated and tested as separators in urine-fed microbial fuel cells (MFCs). The results reveal that the presence of iron oxide in the ceramic membrane composition increases the structural porosity and reduces the pore size for the three temperatures investigated. On the other hand, it was also observed that the iron content mitigates the negative effect of the high sintering temperature on the power performance of the MFCs. In the case of the ceramic membranes sintered at 1300 °C, power output improved ca. 10-fold when the iron oxide content in the membrane increased from 1.06 up to 5.75 vol.% (30.9 and 286.6 µW, respectively). Amongst the different combinations of iron phase content and sintering temperatures, the maximum power output was obtained by MFCs working with separators containing 5.75 vol. % of iron oxide and sintered at 1100 °C (1.045 mW). Finally, the system was stable for 65 days, which supports the long-term functionality of the different materials assessed.

Optimisation of the internal structure of ceramic membranes for electricity production in urine-fed microbial fuel cells.

The need to find a feasible alternative to commercial membranes for microbial fuel cells (MFCs) poses an important challenge for the practical implementation of this technology. This work aims to analyse the influence of the internal structure of low-cost terracotta clay-based membranes on the behaviour of MFCs. To this purpose, 9 different combinations of temperature and time were used to prepare 27 MFC separators. The results show that the temperature has a significant effect on both porosity and pore size distribution, whereas the ramp time do not show a significant influence on these parameters. It was observed that kilning temperatures higher than 1030 °C dramatically reduce the porosity of the samples, reaching a minimum value of 16.85%, whereas the pore size increases as the temperature also increases. Among the membranes with similar porosities, those with a medium pore size distribution exhibited the lowest bulk resistance allowing MFCs to reach the highest power output (94.67 µW cm-2). These results demonstrate the importance of not only the porosity but also the pore size distribution of the separator in terms of MFC performance and longevity, which for these experiments was for 90 days.

Evaluation of artificial neural network algorithms for predicting the effect of the urine flow rate on the power performance of microbial fuel cells.

Microbial fuel cell (MFC) power performance strongly depends on the biofilm growth, which in turn is affected by the feed flow rate. In this work, an artificial neural network (ANN) approach has been used to simulate the effect of the flow rate on the power output by ceramic MFCs fed with neat human urine. To this aim, three different second-order algorithms were used to train our network and then compared in terms of prediction accuracy and convergence time: Quasi-Newton, Levenberg-Marquardt, and Conjugate Gradient. The results showed that the three training algorithms were able to accurately simulate power production. Amongst all of them, the Levenberg-Marquardt was the one that presented the highest accuracy (R = 95%) and the fastest convergence (7.8 s). These results show that ANNs are useful and reliable tools for predicting energy harvesting from ceramic-MFCs under changeable flow rate conditions, which will facilitate the practical deployment of this technology.

Improving the power performance of urine-fed microbial fuel cells using PEDOT-PSS modified anodes.

The need for improving the energy harvesting from Microbial Fuel Cells (MFCs) has boosted the design of new materials in order to increase the power performance of this technology and facilitate its practical application. According to this approach, in this work different poly(3,4-ethylenedioxythiophene)-polystyrenesulfonate (PEDOT-PSS) modified electrodes have been synthesised and evaluated as anodes in urine-fed MFCs. The electrochemical synthesis of PEDOT-PSS was performed by potentiostatic step experiments from aqueous solution at a fixed potential of 1.80 V (vs. a reversible hydrogen electrode) for different times: 30, 60, 120 and 240 s. Compared with other methods, this technique allowed us not only to reduce the processing time of the electrodes but also better control of the chemical composition of the deposited polymer and therefore, obtain more efficient polymer films. All modified anodes outperformed the maximum power output by MFCs working with the bare carbon veil electrode but the maximum value was observed when MFCs were working with the PEDOT-PSS based anode obtained after 30 s of electropolymerisation (535.1 µW). This value was 24.3% higher than using the bare carbon veil electrode. Moreover, the functionality of the PEDOT-PSS anodes was reported over 90 days working in continuous mode.

Does the Antitumor Necrosis Factor-α Therapy Decrease the Vertebral Fractures Occurrence in Inflammatory Bowel Disease?

BACKGROUND/OBJECTIVE: Osteoporosis and osteoporotic fracture risk are extraintestinal manifestations of the inflammatory bowel disease, whose etiopathogenic mechanisms have not been determined yet. Anti-tumor necrosis factor (TNF)-α are used in treatment of inflammatory bowel disease (IBD), but it is unknown if they play a role in osteoporotic fracture prevention. The objective of this study was to know if anti-TNF decreases fracture risk or modifies bone mineral density. To determine the possible risk factors associated with fractures, and assess the incidence of vertebral fractures in IBD patients. METHODS: Longitudinal prospective cohort study (7 yr of follow-up); which included 71 IBD patients, 23 received anti-TNF-α; the remaining 48 received conventional treatment, constituted the control group. Patients participated in a questionnaire which gathered risk factors associated with the development of osteoporosis and fractures. Radiographs of the dorsolumbar-spine were performed and also a bone density measurement. Their biochemical and bone remodeling parameters were determined. RESULTS: Although patients who did not receive anti-TNF-α, suffered more fractures but biologic therapy did not reduce the risk of new vertebral fractures. The increase of bone mass was significantly higher the group treated with anti-TNF-α. The increase in the lumbar spine was of 8% and in the femoral neck was of 6.7%. The only determinant factor for the incidence of vertebral fractures was a history of previous fractures (odds ratio of 12.8; confidence interval 95% 2.37-69.9; p = 0.003). The incidence of vertebral fractures in IBD patients was considerably high: 26.7/700 patient-yr. CONCLUSIONS: Anti-TNF-α, although increased bone mass in these patients, did not reduce the risk of new vertebral fractures. In this study, patients with IBD have a considerably high incidence of fractures. Only the existence of previous vertebral fractures was a predictive factor for consistent fractures.

Towards the optimisation of ceramic-based microbial fuel cells: A three-factor three-level response surface analysis design.

Microbial fuel cells (MFCs) are an environment-friendly technology, which addresses two of the most important environmental issues worldwide: fossil fuel depletion and water scarcity. Modelling is a useful tool that allows us to understand the behaviour of MFCs and predict their performance, yet the number of MFC models that could accurately inform a scale-up process, is low. In this work, a three-factor three-level Box-Behnken design is used to evaluate the influence of different operating parameters on the performance of air-breathing ceramic-based MFCs fed with human urine. The statistical analysis of the 45 tests run shows that both anode area and external resistance have more influence on the power output than membrane thickness, in the range studied. The theoretical optimal conditions were found at a membrane thickness of 1.55 mm, an external resistance of 895.59â€¯Ω and an anode area of 165.72 cm2, corresponding to a maximum absolute power generation of 467.63 µW. The accuracy of the second order model obtained is 88.6%. Thus, the three-factor three-level Box-Behnken-based model designed is an effective tool which provides key information for the optimisation of the energy harvesting from MFC technology and saves time in terms of experimental work.

Modelling the energy harvesting from ceramic-based microbial fuel cells by using a fuzzy logic approach.

Microbial fuel cells (MFCs) is a promising technology that is able to simultaneously produce bioenergy and treat wastewater. Their potential large-scale application is still limited by the need of optimising their power density. The aim of this study is to simulate the absolute power output by ceramic-based MFCs fed with human urine by using a fuzzy inference system in order to maximise the energy harvesting. For this purpose, membrane thickness, anode area and external resistance, were varied by running a 27-parameter combination in triplicate with a total number of 81 assays performed. Performance indices such as R2 and variance account for (VAF) were employed in order to compare the accuracy of the fuzzy inference system designed with that obtained by using nonlinear multivariable regression. R2 and VAF were calculated as 94.85% and 94.41% for the fuzzy inference system and 79.72% and 65.19% for the nonlinear multivariable regression model, respectively. As a result, these indices revealed that the prediction of the absolute power output by ceramic-based MFCs of the fuzzy-based systems is more reliable than the nonlinear multivariable regression approach. The analysis of the response surface obtained by the fuzzy inference system determines that the maximum absolute power output by the air-breathing set-up studied is 450  µ W when the anode area ranged from 160 to 200 cm2, the external loading is approximately 900 Ω and a membrane thickness of 1.6 mm, taking into account that the results also confirm that the latter parameter does not show a significant effect on the power output in the range of values studied.

Clinical repercussions and epidemiological considerations of supernumerary canines: A 26 case series.

BACKGROUND: To establish the prevalence of supernumerary canines (SNC) in a sector of the population of Madrid (Spain), as well possible complications associated with this unusual developmental variation. STUDY DESIGN: This observational study was performed between 2005 and 2017, among 21,615 patients seeking dental treatment at the Faculty of Dentistry, Complutense University of Madrid (Spain), and at the Virgen de la Paloma Hospital, Madrid (Spain); 22 patients with 26 SNCs were diagnosed. These 22 patients underwent clinical and radiological exploration, registering patient data. RESULTS: SNCs presented a prevalence of 0.10% of the study population. The supernumerary teeth (SNT) were located in the upper maxilla more frequently (61.54%) than the mandible (38.46%). 69.23% were found to be impacted, also causing the impaction of the permanent canine in 53.85% of these cases. In 15.38%, follicular expansion > 3mm was observed. SNCs were associated with other SNT in only four patients. CONCLUSIONS: Despite of the fact that the SNCs are usually diagnosed casually in the course of radiological exploration, in the present study over half of them (53.85%) caused impaction of the permanent canine. Early diagnosis allows optimal patient management and treatment planning, with intervention at an appropriate time to prevent complications in development and so reduce later treatment need.

A study of the dental treatment needs of special patients: cerebral paralysis and Down syndrome.

AIM: The aim of the present study was to compare the dental characteristics and the oral health care needs of patients with Cerebral Paralysis (CP) and Down Syndrome (DS). MATERIALS AND METHODS: The selected sample consisted of 28 patients of both sexes between 10 and 20 years of age. STUDY DESIGN: observational, descriptive and cross-sectional study. STATISTICS: The statistical analysis was carried out with the SPSS 19.0 program for Windows. The frequency distribution and contingency tables were analysed, as was interobserver concordance. non mi è chiaro cosa intendono qui. RESULTS: Fifty percent of the patients with CP presented dental traumas, compared to 15% of the patients with DS. Dental prophylaxis was the most prevalent treatment in both groups (77% in CP compared to 86.7% in DS). The most frequent habit was oral breathing, which was found in 69.2% of the patients with CP and 80% of those with DS. CONCLUSIONS: Patients with CP and DS require early dental care in order to prevent and limit the severity of the pathologies observed.

Validation and incidence of community-acquired pneumonia in patients with type 2 diabetes in the BIFAP database.

Oral anti-diabetic drugs (OADs) have been associated with community-acquired pneumonia (CAP). We aimed to validate the recording of CAP in the Spanish Database for Pharmacoepidemiological Research in Primary Care (BIFAP) for the future evaluation of OAD-CAP association. The incidence rate (IR/1000 person-years) of CAP in type 2 diabetes mellitus (T2DM) was also determined. In total, 2966 pneumonia records (2040 listed as diagnosis and 926 as identified from comments added by physicians) were identified from 76 009 patients with T2DM after the first OAD in 2002-2013. Data around the CAP date were reviewed: 1803 (60·9%) were classified as 'probable CAP' (confirmed by X-ray/laboratory, referral letters or CAP lung site); 589 (19·8%) as 'no-case' (486 had other illness, 78 previous CAP, 25 cancer); and 574 (19·4%) as 'possible CAP' (441 without confirmatory information, 133 with uncertain diagnosis or uncertain diagnosis date). In total, 74·2% and 31·4% of pneumonia records in the diagnosis and comments, respectively, were 'probable cases' (IR: 6·04), which increased to 90·5% and 42·9%, respectively, when the 441 'possible cases' without confirmatory information were included (IR: 7·52). In summary, diagnosis had a high positive predictive value, and adding cases automatically detected from comments decreased that value significantly.

Serous tubal intraepithelial carcinomas associated with high-grade serous ovarian carcinomas: a systematic review.

BACKGROUND: Serous tubal intraepithelial carcinomas (STICs) have been documented in high-grade serous ovarian carcinomas (HGSOCs). However, the rate of association between STICs and HGSOCs and, therefore, the fraction of HGSOCs that are likely to have originated from the fallopian tube (FT), has remained unclear. OBJECTIVE: To appraise the literature describing the association between STICs and established HGSOCs. SEARCH STRATEGY: Ovid MEDLINE and EMBASE were searched. SELECTION CRITERIA: Studies were included if they evaluated the frequency of STICs in HGSOCs, and were published in an English peer-reviewed journal. DATA COLLECTION AND ANALYSIS: Appropriate studies were evaluated for their compliance with the 'Strengthening and Reporting of Observational Studies in Epidemiology (STROBE)' criteria. MAIN RESULTS: Ten articles met the study selection criteria. The reported coexistence between STICs and HGSOCs ranged from 11% to 61% (mean: 31%, 95% CI: 17-46%). STICs were rarely found in other gynaecological cancers. Small sample size, lack of objective criteria to identify STICs and the retrospective nature of the studies contributed to the variability in reporting the rate of the association. CONCLUSIONS: STICs were identified commonly in the FTs of women with HGSOC. Finding the true rate of association between STICs and HGSOCs will require further investigations. While there is evidence that a fraction of HGSOCs arise from the FTs, an accurate estimate of that fraction remains to be determined. The lack of an accurate estimate of the association makes it difficult to evaluate the potential magnitude of reduction of HGSOCs following prophylactic salpingectomy. TWEETABLE ABSTRACT: A systematic review of the incidence of STICs in HGSOCs identifies significant methodological inconsistencies.

[Prevention of the wound infection: little changes, huge results]. / Resultados de la modificación de la actitud ante la asepsia en cirugía neonatal: pequeños cambios, grandes resultados.

INTRODUCTION: Neonatal surgical wound infection occurs in almost 50% of neonatal procedures. It increases the rates of morbimortality in neonatal units. There is no guidelines about prevention of wound infection in neonatal surgery. We present our results after changing our behaviour in neonatal surgery. MATERIALS AND METHODS: Comparative study between 2 groups. In order to decrease wound infection at the end of the procedure gloves, covertures and surgical instruments were changed and saline and antiseptic solutions were used during laparotomy closing. Group P included procedures with these recommendations and Group NP without them. Age, weight, surgery, infection, length of stay, and mortality were analized between groups through a logistic regression model. RESULTS: Group P included 55 procedures in 32 patients, median weight 1,300 g (1,000-2,100), 19 median days of life (6-40), 5 postoperative wound problems (9%). Group NP included 26 procedures in 14 neonates, median weight 1,700 g (700-2,500), 20 median days of life (3-33), 14 wound problems (53.8%). We decrease the wound problems in our patients in 44.8% (p < 0.0001). Additionally, the protection provided by our recommendations was maintained after adjustment by weight, age and type of pathology (0.07) p= 0.000. CONCLUSIONS: Simple changes in during the procedures in neonatal surgery can reduce the appearance of wound infection and morbidity.

OBJETIVOS: La infección de herida quirúrgica neonatal tiene una incidencia de hasta el 50% y produce un aumento de morbimortalidad. No existen recomendaciones preventivas consensuadas en la literatura. Presentamos los resultados tras la implantación de un protocolo creado en nuestro Servicio para cierre de laparotomía en cirugía neonatal contaminada y sucia. MATERIAL Y METODOS: Estudio ambispectivo de las laparotomías neonatales realizadas durante 32 meses comparando los resultados con un grupo de pacientes intervenidos durante un período previo similar. El protocolo incluye cambio de guantes, de campo y material quirúrgico, lavado por planos con antiséptico y sutura antibacteriana en el cierre. Se analizan edad, peso, tipo de intervención, infección, estancia hospitalaria y mortalidad y se compara con un grupo similar de pacientes intervenidos de forma previa a la creación del protocolo (NP) y se analiza la influencia del protocolo en la aparición de infección mediante regresión logística. RESULTADOS: El grupo P incluye 55 laparotomías en 32 neonatos con mediana de peso 1.300 g (1.000-2.100), mediana de edad 19 días (6-40) con 3 infecciones de herida (2 cultivos positivos) y 2 dehiscencias leves (9%). El grupo NP incluyó 26 intervenciones en 14 neonatos, mediana de peso 1.700 g (700-2.500), mediana de edad 20 días (3-33), 14 infecciones (53,8%), 8 cultivos positivos y 2 muertes. Se redujo un 44,8% la aparición de infección (p < 0,0001) y el efecto protector del protocolo se mantuvo después del ajuste por peso, edad y tipo de patología (0,07) p= 0,000. CONCLUSIONES: La sencilla modificación de la asepsia y técnica de cierre ha contribuido a disminuir considerablemente la tasa de infección y morbimortalidad en nuestros pacientes y consideramos que es necesario hacer conciencia de ello.

[Management protocol in gastroschisis]. / Protocolo de manejo en las gastrosquisis.

AIM: There are two classical managements in gastroschisis: primary or delayed closure. From 2007 on, a multidisciplinary approach protocol based in preterm caesarean delivery at 34-35th gestational age (in order to minimize peel injury) plus primary closure is followed in our institution. Prior to this, term delivery, either by caesarean section or not, was the rule. METHODS: Retrospective study of gastroschisis's patients before (1978-2006) and after (2007-2016) protocol approval. Complex gastroschisis frequency, peel's presence, primary or delayed closure, complications, re-interventions, neonatal intensive care unit (NICU) length of stay, age at onset of enteral nutrition, total parenteral nutrition's length and length of stay were compared. MAIN RESULTS: Study groups: before (12 patients) and after (13 newborns) the protocol implantation (pre/post). Nine complex gastroschisis were observed in the pre-protocol period, compared to one in the post-protocol era (p= 0.001). The re-interventions also decreased: 58.33% in the pre-protocol vs. 15.38% in the post-protocol group (p= 0.025). Complications rate were 66.67% before protocol vs. 23.07% after protocol (p= 0.028). NICU length of stay decreased from 40 ± 32 to 17 ± 12 days (p= 0.025). Parenteral total nutrition length was 61 ± 36 in the pre-protocol vs. 15 ± 6 in the port-protocol eras, respectively (p= 0.043). The age at onset of enteral nutrition was 34 ± 26 vs. 9 ± 5 days (p= 0.004) and hospitalization length was 98 ± 81 days pre vs. 35 ± 15 days post protocol implantation (p= 0.011). CONCLUSIONS: The protocol implantation has allowed primary closure, decreased hospitalization; reduced complications and mortality rate as well.

OBJETIVOS: Clásicamente existen dos manejos de las gastrosquisis: cierre directo o diferido. Nosotros apostamos por el cierre directo aplicando un protocolo de actuación en el que se programa cesárea a las 34-35 semanas de gestación para minimizar el "peel". MATERIAL Y METODO: Estudio retrospectivo de los pacientes con gastrosquisis en los períodos pre (1978-2006) y post (2007-2016) implantación del protocolo, comparando frecuencia de gastrosquisis complejas, la presencia o ausencia de peel, cierre directo o diferido, complicaciones, reintervenciones, días de ingreso en unidad de cuidados intensivos, edad al inicio de nutrición enteral, nutrición parenteral total y días de hospitalización. RESULTADOS: Grupo de estudio: previo (12) y posterior (13) al protocolo (previo/post). La frecuencia de gastrosquisis complejas en el período previo fue de 9 neonatos, en el período post solo 1 (p= 0,001). El número de reintervenciones fue de 58,33% previo vs. 15,38% post (p= 0,025). Las complicaciones postoperatorias fueron 66,67% previo frente a 23,07% post (p= 0,028) y existió una disminución de los días de estancia en la unidad de cuidados intensivos de 40 ± 32 vs. 17 ± 12 (p= 0,025) y de los días de nutrición parenteral (61 ± 36 frente a 15 ± 6; p= 0,043). La edad al inicio de la nutrición enteral fue de 34 ± 26 vs. 9 ± 5 días (p= 0,004) y los días de hospitalización fueron de 98 ± 81 días previo frente a 35 ± 15 días post protocolo (p= 0,011). CONCLUSIONES: La implantación del protocolo ha permitido el cierre directo, la disminución de la estancia hospitalaria, de las complicaciones y de la mortalidad.

Cognitive plasticity as a moderator of functional dependency in elderly patients hospitalized for bone fractures.

INTRODUCTION: Bone fractures in older adults involve hospitalization and surgical intervention, aspects that have been related to loss of autonomy and independence. Several variables have been studied as moderators of how these patients recover. However, the implications of cognitive plasticity for functional recovery have not been studied to date. OBJECTIVE: The present study analyzes the relationship between cognitive plasticity--defined as the capacity for learning or improved performance under conditions of training or performance optimization--and functional recovery in older adults hospitalized following a bone fracture. PATIENTS AND METHODS: The study comprised 165 older adults who underwent surgery for bone fractures at a hospital in southern Spain. Participants were evaluated at different time points thereafter, with instruments that measure activities of daily life (ADL), namely the Barthel Index (BI) and the Lawton Index, as well as with a learning potential (cognitive plasticity) assessment test (Auditory Verbal Learning Test of Learning Potential, AVLT-LP). RESULTS: Results show that most of the participants have improved their level of independence 3 months after the intervention. However, some patients continue to have medium to high levels of dependency and this dependency is related to cognitive plasticity. CONCLUSION: The results of this study reveal the importance of the cognitive plasticity variable for evaluating older adults hospitalized for a fracture. They indicate a possible benefit to be obtained by implementing programs that reduce the degree of long-term dependency or decrease the likelihood of it arising.

[Implementation of a Plan of Patient Safety in Service of Pediatric Surgery. First results]. / Implementación de un Plan de Seguridad del Paciente en un Servicio de Cirugía Pediátrica. Primeros resultados.

OBJECTIVES: In 2014 our department starts to apply the PatientSafety Strategic in Pediatric Surgery. Our aim is to describe the results obtained. METHODS: For the measurement of adverse events (AE) we used a modification of the Global Trigger Tool of the Institute for Healthcare Improvement. Population analysed: patients undergoing surgery with hospitalization. On a monthly basis, audits of the medical records of 12 patients discharged in the prior week of the assessment were performed. The evaluation team was composed by experienced pediatric surgeon, two staff nurses, and a doctor and nurse from the Quality Department. RESULTS: 95 clinical records and a total of 406 days of hospital stay were reviewed. 31 patients (32.6%) experienced one or more AE. Total AE: 43. The AE/1000 patients/day ratio: 105.9. The most common AE were: vomiting, itching and pain. 28 EA were considerd mild and 3 moderate in severity, according to the classification of the National Coordinating Council for Medication Error Reporting and Prevention. No EA were considered serious or critical. CONCLUSIONS: The analysis of prevalence through regular assessments of medical records is an easy method to obtain information about the frequency of occurrence, exact understanding of the AE types and the implementation of corrective measures. The main limitation of this method is that it can miss some of the serious EA and miss the records and analysis of sentinel events that may occur in the period between assessments.

OBJETIVOS: Durante el año 2014 se aplica el Plan de Seguridad del Paciente en un Servicio de Cirugía Pediátrica, elaborado previamente por nuestro Servicio. Se describen los resultados. MATERIAL Y METODOS: El método empleado para la medición de eventos adversos (EAs) es una modificación del Global Trigger Tool del Institute for Health care Improvement. Población analizada: pacientes intervenidos quirúrgicamente con hospitalización. Con una periodicidad mensual, se realizaron 12 auditorias de las historias clínicas correspondientes a los pacientes dados de alta en la semana anterior al día de la evaluación. El equipo evaluador estaba compuesto por: un cirujano pediátrico experto, dos enfermeras de planta más un médico y una enfermera del Servicio de Calidad. RESULTADOS: Se revisaron 95 historias y 406 días de estancia. 31 pacientes (32,6%) sufrieron uno o más eventos adversos. Total EAs: 43. Número EAs/1.000 pacientes/día: 105,9. Los 3 EA más frecuentes fueron: vómitos, prurito y dolor. 28 EAs fueron de gravedad leve y 3 moderada, según la clasificación del National Coordinating Council for Medication Error Reporting and Prevention. Ningún EA fue grave o crítico. CONCLUSIONES: La determinación de la prevalencia mediante evaluaciones regulares de historias clínicas es un método que permite obtener información de forma fácil sobre la frecuencia de aparición, el conocimiento exacto de los tipos de EAs y la aplicación de medidas correctoras. Este método tiene como limitación principal la posible falta de recogida EAs graves así como registro y análisis de eventos centinelas que pueden ocurrir en el periodo entre evaluaciones.

[Neonatal surgical site infection: multicentric survey on prophylactic measures]. / Infección de herida quirúrgica neonatal: encuesta multicéntrica sobre medidas profilácticas.

OBJECTIVES: Surgical site infection (SSI) has a considerable impact on neonatal morbidity. There are known risk factors such type of surgery (clean/contaminated), prematurity, surgical length, hypoalbuminemia, previous infection, prolonged mechanical ventilation, and so on. Many perioperative factors have not been studied, opposite to adults. We have developed a survey on intraoperative attitudes and measures, as surgical wound management in Neonates among pediatric surgeons, to seek for a wider consense. METHODS: Multi-response survey with 22 items, based on the Surgical Infection Society NIH 2008 clinical guideline. Each item poses a question on perioperative attitudes, surgical aspects and wound management. Each question is subdivided in two categories, depending on urgency and type of surgery (clean/contaminated). RESULTS: 159 surveys were sent. Among those, we received back 51 (32%). 69% of the interviewed surgeons use clorhexidin to prepare surgical field, 25% use Iodine solutions. 69% never use diathermy to incise skin. There was no agreement on the use of sterile plastic adhesive drapes, intra-cavity lavage, changing surgical gloves/material, or wound irrigation during closure. 82% never use cyanocrilate dressing. Intracuticular skin suture and simple stitches were used indistinctly. Wound management and dressings were not uniform and depended on each pediatric unit. CONCLUSIONS: The survey reflects the lack of consensus regarding prophylactic measures and wound management among pediatric surgeons who care after surgical neonates.

OBJETIVOS: La infección de herida quirúrgica (IHQ) es una causa frecuente de morbimortalidad en Neonatología. Existen factores de riesgo conocidos: tipo de cirugía (sucia/contaminada/limpia), prematuridad, duración de intervención, hipoalbuminemia, infección previa, ventilación mecánica prolongada y contaminación de vía central. Otros factores perioperatorios no han sido estudiados en neonatos, sí en adultos. Desarrollamos una encuesta sobre las actitudes y las medidas, intraoperatorias y de manejo de herida. Pretendemos dilucidar si existe consenso sobre la profilaxis de IHQ neonatal. METODOS: Encuesta con 22 ítems, basada en la guía de prevención de la IHQ en adultos (Surgical Infection Society, 2008). Cada ítem cuestiona temas sobre hábitos perioperatorios, intra y postoperatorios, relacionados con el manejo de la herida quirúrgica en el neonato, y consta de dos preguntas, según sea cirugía sucia/urgente o limpia/contaminada. Las opciones de respuesta son 4: siempre, con frecuencia, raramente y nunca. Enviamos la encuesta a cirujanos pediátricos españoles mediante correo electrónico en el primer trimestre del 2012. RESULTADOS: Se enviaron 159 encuestas. 51 (32%) respondieron. 69% emplean clorhexidina para preparar campo, 25% usan povidona iodada. Solo el 51% refirió dejar actuar siempre un minuto el antiséptico. 69% nunca usan bisturí eléctrico en piel para ampliar herida. No hubo respuestas unánimes en cuanto al uso de paños adhesivos protectores del campo, la irrigación de planos con suero o antisépticos durante el cierre, el empleo de drenajes, cambio de guantes y/o material al iniciar el cierre (cirugía sucia). El 72% y el 82% nunca emplean cianocrilato como cierre o apósito en neonatos, respectivamente. En cirugía sucia, 43% suturan piel con intradérmica y 49% con puntos sueltos. CONCLUSIONES: La distribución de respuestas refleja la falta de consenso sobre los aspectos de la técnica quirúrgica y el manejo perioperatorio que podrían estar relacionados con la profilaxis de IHQ neonatal.

Biofilm formation is not a prerequisite for production of the antibacterial compound tropodithietic acid in Phaeobacter inhibens DSM17395.

AIMS: The goal of this study was to investigate if biofilm formation on population level is a physiological requirement for antagonism in Phaeobacter inhibens DSM17395, since the antibiotic compound tropodithietic acid (TDA) is produced by several Roseobacter clade species during growth as multicellular aggregates or biofilms at the air-liquid interface and is induced on single cell level upon attachment. METHODS AND RESULTS: A mutant library was created by Tn5 transposon insertion and 22 TDA-positive (brown) mutants with decreased biofilm formation or adhesion, and eight TDA-negative (white) mutants with increased biofilm formation or adhesion were selected. None of the selected biofilm-overproducing white mutants showed any antibiotic activity, while all brown mutants with reduced or disabled biofilm formation produced the antibacterial compound. Sequencing analysis indicated that genes that are likely involved in EPS/LPS production, motility and chemotaxis, and redox regulation play a role in biofilm formation and/or adhesion in P. inhibens DSM17395. CONCLUSIONS: Cell aggregation and biofilm formation are not physiological prerequisites for TDA production. SIGNIFICANCE AND IMPACT OF THE STUDY: This study contributes to the understanding of TDA production in P. inhibens, which has great potential as a probiotic in marine larviculture.