The legacy of past droughts induces water-sparingly behaviour in Grüner Veltliner grapevines.

Drought is becoming more frequent and severe in numerous wine-growing regions. Nevertheless, limited research has examined the legacy of recurrent droughts, focusing on leaf physiology and anatomy over consecutive seasons. We investigated drought legacies (after 2 years of drought exposure) in potted grapevines, focusing on stomatal behaviour under well-watered conditions during the third year. Vines were subjected for two consecutive years to short- (SD) or long-term (LD) seasonal droughts, or well-watered conditions (WW). In the third year, all plants were grown without water limitation. Water potential and gas exchange were monitored throughout the three seasons, while leaf morpho-anatomical traits were measured at the end of the third year. During droughts (1st and 2nd year), stem water potential of SD and LD plants fell below -1.1 MPa, with a consequent 75% reduction in stomatal conductance (gs ) compared to WW. In the 3rd year, when all vines were daily irrigated to soil capacity (midday stem water potential ~ -0.3 MPa), 45% lower values of gs were observed in the ex-LD group compared to both ex-SD and ex-WW. Reduced midrib vessel diameter, lower leaf theoretical hydraulic conductivity, and smaller stomata were measured in ex-LD leaves compared to ex-SD and ex-WW, likely contributing to the reduced gas exchange. Our findings suggest that grapevines exposed to drought may adopt a more water-conserving strategy in subsequent seasons, irrespective of current soil water availability, with the degree of change influenced by the intensity and duration of past drought events.

Simultaneously Targeting Two Coupled Signalling Molecules in the Mesenchymal Stem Cell Support Efficiently Sensitises the Multiple Myeloma Cell Line H929 to Bortezomib.

Several studies have shown that diverse components of the bone marrow (BM) microenvironment play a central role in the progression, pathophysiology, and drug resistance in multiple myeloma (MM). In particular, the dynamic interaction between BM mesenchymal stem cells (BM-MSC) and MM cells has shown great relevance. Here we showed that inhibiting both PKC and NF-κB signalling pathways in BM-MSC reduced cell survival in the MM cell line H929 and increased its susceptibility to the proteasome inhibitor bortezomib. PKC-mediated cell survival inhibition and bortezomib susceptibility induction were better performed by the chimeric peptide HKPS than by the classical enzastaurin inhibitor, probably due to its greatest ability to inhibit cell adhesion and its increased capability to counteract the NF-κB-related signalling molecules increased by the co-cultivation of BM-MSC with H929 cells. Thus, inhibiting two coupled signalling molecules in BM-MSC was more effective in blocking the supportive cues emerging from the mesenchymal stroma. Considering that H929 cells were also directly susceptible to PKC and NF-κB inhibition, we showed that treatment of co-cultures with the HKPS peptide and BAY11-7082, followed by bortezomib, increased H929 cell death. Therefore, targeting simultaneously connected signalling elements of BM-MSC responsible for MM cells support with compounds that also have anti-MM activity can be an improved treatment strategy.

Assessment of wastewater-borne pharmaceuticals in tissues and body fluids from riverine fish.

Riverine fish in densely populated areas is constantly exposed to wastewater-borne contaminants from effluent discharges. These can enter the organism through the skin, gills or by ingestion. Whereas most studies assessing the contaminant burden in exposed fish have focused either on muscle or a limited set of tissues. Here we set out to generate a more comprehensive overview of the distribution of pollutants across tissues by analyzing a panel of matrices including liver, kidney, skin, brain, muscle, heart, plasma and bile. To achieve a broad analyte coverage with a minimal bias towards a specific contaminant class, sample extracts from four fish species were analyzed by High-Performance Liquid Chromatography (HPLC) - high-resolution mass spectrometry (HRMS) for the presence of 600 wastewater-borne pharmaceutically active compounds (PhACs) with known environmental relevance in river water through a suspect-screening analysis. A total of 30 compounds were detected by suspect screening in at least one of the analyzed tissues with a clear prevalence of antidepressants. Of these, 15 were detected at confidence level 2.a (Schymanski scale), and 15 were detected at confidence level 1 following confirmation with authentic standards, which furthermore enabled their quantification. The detected PhACs confirmed with level 1 of confidence included acridone, acetaminophen, caffeine, clarithromycin, codeine, diazepam, diltiazem, fluoxetine, ketoprofen, loratadine, metoprolol, sertraline, sotalol, trimethoprim, and venlafaxine. Among these substances, sertraline stood out as it displayed the highest detection frequency. The values of tissue partition coefficients for sertraline in the liver, kidney, brain and muscle were correlated with its physicochemical properties. Based on inter-matrix comparison of detection frequencies, liver, kidney, skin and heart should be included in the biomonitoring studies of PhACs in riverine fish.

Eficacia de la tromboprofilaxis con heparina de bajo peso molecular en pacientes críticos con COVID-19: estudio observacional, prospectivo y multicéntrico / Effectiveness of thromboprophylaxis with low molecular weight heparin in critically ill patients with COVID-19. An observational prospective, multicenter study

Introducción: Los pacientes COVID-19 presentan una coagulopatía caracterizada por una elevada incidencia de complicaciones tromboembólicas. Ante la controversia existente sobre el manejo de la tromboprofilaxis, se llevó a cabo un estudio con el objetivo de analizar el efecto de las diferentes dosis de heparina de bajo peso molecular (HBPM) utilizadas en los pacientes críticos con COVID-19. Material y métodos: Se evaluaron datos del Reg-COVID-19. Se compararon 2 grupos de pacientes según la dosis de HBPM administrada: profilaxis y tratamiento. El objetivo primario fue determinar si había relación de la dosis de HBPM con la mortalidad. Los objetivos secundarios incluyeron la incidencia de eventos trombóticos y hemorrágicos, la duración de la estancia en la UCI, la ventilación mecánica invasiva y los parámetros trombóticos e inflamatorios. Resultados: Se analizaron datos de 720 pacientes, 258 en el grupo de profilaxis y 462 en el de tratamiento. La proteína C reactiva, la ventilación mecánica invasiva y el tratamiento con tocilizumab o corticosteroides se relacionaron con la elección de la dosis de HBPM. La incidencia de complicaciones hemorrágicas (66/720, 9,2%) y trombóticas (69/720, 9,6%) fue similar en ambos grupos, al igual que el curso temporal de los eventos trombóticos, que ocurrieron antes que los hemorrágicos (9 [3-18] y 12 [6-19] días, respectivamente). La mortalidad fue menor en el grupo de profilaxis (25,2 frente al 35,1%), pero al aplicar un modelo de ponderación de probabilidad inversa, no se encontraron diferencias entre los grupos. Conclusión: No se encontraron efectos beneficiosos ni perjudiciales relacionados con la administración de dosis profilácticas o terapéuticas de HBPM en pacientes críticos COVID-19, con una tasa similar de complicaciones hemorrágicas o trombóticas. A partir de estos resultados, consideramos que son necesarios más estudios para determinar el protocolo óptimo de tromboprofilaxis en estos pacientes.(AU)

Introduction: COVID-19 induces coagulopathy associated with an increase of thromboembolic events. Due to the lack of agreement on recommendations for thromboprophylactic management, the aim of this study was to study the dosages of LMWH used in critically ill COVID-19 patients assessing the effect on their outcome. Metohds: We evaluated data of the Reg-COVID19. According to LMWH dose two groups were analyzed: prophylaxis and treatment. Primary outcome was the relationship of LMWH dosage with mortality. Secondary outcomes included the incidence of thrombotic and bleeding events, length of ICU stay, invasive mechanical ventilation, and thrombotic and inflammatory parameters. Results: Data of 720 patients were analyzed, 258 in the prophylaxis group and 462 in the treatment group. C Reactive Protein, invasive mechanical ventilation, tocilizumab and corticosteroid treatments were related with the choice of LMWH dose. Hemorrhagic events (66/720, 9.2%) and thrombotic complications (69/720, 9.6%) were similar in both groups (P=.819 and P=.265), as was the time course of the thrombotic events, earlier than hemorrhagic ones (9 [3-18] and 12 [6-19] days respectively). Mortality was lower in prophylaxis group (25.2% versus 35.1%), but once an inverse probability weighting model was applied, we found no effect of LMWH dose. Conclusion: We found no benefit or harm with the administration of therapeutic or prophylactic LMWH dose in COVID19 critically ill patients. With a similar rate of hemorrhagic or thrombotic events, the LMWH dose had no influence on mortality. More studies are needed to determine the optimal thromboprophylaxis protocol for critically ill patients.(AU)

An in silico study on the influence of extracellular matrix mechanics on vasculogenesis.

BACKGROUND AND OBJECTIVES: Blood vessels form a network of capillaries throughout the body that perform essential functions for life. Vasculogenesis, i.e. the formation of new blood vessels, is regulated by many factors, biochemical ones being among the most important. However, others such as the biomechanical influence on shape, organization and structure of vessel networks require further investigation. In this paper, we develop a 3D agent-based mechanobiological model of vasculogenesis with the aim of analyzing how the mechanics of the extracellular matrix (ECM) affects vasculogenesis. METHODS: For this purpose, we consider a growing domain composed of different cells: tip cells, which are the driving cells located at the end of the vessels and stalk cells, which are found in the interior of the vascular network. ECM is considered as particles (agents) that surround the growth of the vascular network. Depending on the cell type, different sets of forces are considered, such as chemotactic, mechanical, random and viscoelastic forces among others. RESULTS: The growth of the network is iteratively analyzed and updated at each time step based on a mechanically-driven proliferation rule. The influence of different biomechanical factors, such as ECM stiffness or viscoelasticity are explored through in silico simulations. A number of indicators are defined along the algorithm, like number of cells, branches, tortuosity and anisotropy, in order to compare topological differences of the vascular network during vasculogenesis under different ECM conditions. The obtained results are qualitatively compared with other related works in the literature. CONCLUSIONS: The present study sheds some light and partially explain, from an in silico perspective, the role of ECM mechanics on vasculogenesis. The main conclusions of this work are: (i) increased stiffness increases proliferation, (ii) the network tends to migrate towards stiffer areas, and (iii) increased viscoelasticity decreases proliferation.

[Cognitive impairment in the elderly patient with symptomatic severe aortic stenosis. Therapeutic decisions and impact on one-year mortality]. / Deterioro cognitivo en el paciente mayor con estenosis aórtica grave sintomática. Toma de decisiones terapéuticas e impacto sobre la mortalidad al año.

INTRODUCTION: Interventional treatment of severe aortic stenosis includes valve replacement by surgery or transcatheter - transcatheter aortic valve implantation (TAVI). In order to make an adequate selection and to rule out patients with little/no therapeutic benefit, it is recommended to assess comorbidities, frailty and cognitive impairment. AIMS: a) To determine the prevalence of cognitive impairment in older patients with severe aortic stenosis; b) to analyse its influence on decision-making (surgery, TAVI or conservative treatment); and c) to analyse its impact on mortality at one year. MATERIAL AND METHODS: Prospective, longitudinal epidemiological study of patients aged 75 years and older with severe aortic stenosis treated by the Heart-Team. VARIABLES: sociodemographic, clinical, cardiological, functional and mental variables; cognitive impairment assessed by applying the Mini-Mental State Examination (MMSE). RESULTS: We included 300 patients in the study (83.99 ± 4.02 years old; 61.2%, women). Prevalence of cognitive impairment of 15.3%, which was associated with albumin level - odds ratio (OR): 0.082; p = 0.011 - and Barthel (OR: 0.962; p = 0.02) and Lawton (OR: 0.787; p = 0.025) index scores. Surgery was chosen in 24.7% of cases; TAVI in 63.3%; and conservative treatment in 12%. This decision was associated with the score on the Barthel (OR: 0.93; p = 0.012) and Lawton indices (OR: 0.678; p = 0.014), the Short Physical Performance Battery (OR: 0.75; p = 0.037) and the MMSE (OR: 0.691; p < 0.001). Mortality at one year was 14%, and higher in patients with MMSE scores <24 (23.5% vs. 12.8%; p = 0.094). CONCLUSIONS: Cognitive impairment is a very common geriatric syndrome in older patients with severe aortic stenosis that is associated with functional disability in activities of daily living. Cognitive impairment has a high impact on decision-making and appears to be a variable associated with increased mortality.

TITLE: Deterioro cognitivo en el paciente mayor con estenosis aórtica grave sintomática. Toma de decisiones terapéuticas e impacto sobre la mortalidad al año.Introducción. El tratamiento intervencionista de la estenosis aórtica grave incluye el recambio valvular mediante cirugía o vía transcatéter ­implante transcatéter de la válvula aórtica (TAVI)­. Para realizar una adecuada selección y descartar pacientes con escaso/nulo beneficio terapéutico, se recomienda evaluar las comorbilidades, la fragilidad y el deterioro cognitivo. Objetivos. a) Determinar la prevalencia de deterioro cognitivo en pacientes mayores con estenosis aórtica grave; b) analizar su influencia en la toma de decisiones (cirugía, TAVI o tratamiento conservador), y c) analizar su impacto sobre la mortalidad al año. Material y métodos. Estudio epidemiológico longitudinal y prospectivo sobre pacientes de 75 años o más con estenosis aórtica grave atendidos por el Heart-Team. Variables: sociodemográficas, clínicas, cardiológicas, funcionales y mentales; deterioro cognitivo evaluado aplicando el Minimental State Examination (MMSE). Resultados. Incluimos a 300 pacientes en el estudio (83,99 ± 4,02 años; 61,2%, mujeres). Prevalencia de deterioro cognitivo del 15,3%, que se asoció con el nivel de albúmina ­odds ratio (OR): 0,082; p = 0,011­ y las puntuaciones en los índices de Barthel (OR: 0,962; p = 0,02) y Lawton (OR: 0,787; p = 0,025). En el 24,7% de los casos se decidió cirugía; en el 63,3%, TAVI; y en el 12%, tratamiento conservador. Esta decisión se asoció con la puntuación en los índices de Barthel (OR: 0,93; p = 0,012) y Lawton (OR: 0,678; p = 0,014), la Short Physical Performance Battery (OR: 0,75; p = 0,037) y el MMSE (OR: 0,691; p menor de 0,001). La mortalidad al año fue del 14%, superior en los pacientes con puntuaciones en el MMSE menor de 24 (23,5% frente a 12,8%; p = 0,094). Conclusiones. El deterioro cognitivo es un síndrome geriátrico muy frecuente en pacientes mayores con estenosis aórtica grave que se asocia con incapacidad funcional en las actividades de la vida diaria. El deterioro cognitivo tiene un elevado impacto en la toma de decisiones y parece presentarse como una variable asociada a mayor mortalidad.

Effectiveness of thromboprophylaxis with low molecular weight heparin in critically ill patients with COVID-19. An observational prospective, multicenter study.

INTRODUCTION: COVID-19 induces coagulopathy associated with an increase of thromboembolic events. Due to the lack of agreement on recommendations for thromboprophylactic management, the aim of this study was to study the dosages of LMWH used in critically ill COVID-19 patients assessing the effect on their outcome. METHODS: We evaluated data of the Reg-COVID19. According to LMWH dose two groups were analyzed: prophylaxis and treatment. Primary outcome was the relationship of LMWH dosage with mortality. Secondary outcomes included the incidence of thrombotic and bleeding events, length of ICU stay, invasive mechanical ventilation, and thrombotic and inflammatory parameters. RESULTS: Data of 720 patients were analyzed, 258 in the prophylaxis group and 462 in the treatment group. C Reactive Protein, invasive mechanical ventilation, tocilizumab and corticosteroid treatments were related with the choice of LMWH dose. Hemorrhagic events (66/720, 9.2%) and thrombotic complications (69/720, 9.6%) were similar in both groups (p = .819 and p = .265), as was the time course of the thrombotic events, earlier than hemorrhagic ones (9 [3-18] and 12 [6-19] days respectively). Mortality was lower in prophylaxis group (25.2% versus 35.1%), but once an inverse probability weighting model was applied, we found no effect of LMWH dose. CONCLUSION: We found no benefit or harm with the administration of therapeutic or prophylactic LMWH dose in COVID19 critically ill patients. With a similar rate of hemorrhagic or thrombotic events, the LMWH dose had no influence on mortality. More studies are needed to determine the optimal thromboprophylaxis protocol for critically ill patients.

[Effectiveness of thromboprophylaxis with low molecular weight heparin in critically ill patients with COVID-19. An observational prospective, multicenter study]. / Eficacia de la tromboprofilaxis con heparina de bajo peso molecular en pacientes críticos con COVID-19: estudio observacional, prospectivo y multicéntrico.

Introduction: COVID-19 induces coagulopathy associated with an increase of thromboembolic events. Due to the lack of agreement on recommendations for thromboprophylactic management, the aim of this study was to study the dosages of LMWH used in critically ill COVID-19 patients assessing the effect on their outcome. Metohds: We evaluated data of the Reg-COVID19. According to LMWH dose two groups were analyzed: prophylaxis and treatment. Primary outcome was the relationship of LMWH dosage with mortality. Secondary outcomes included the incidence of thrombotic and bleeding events, length of ICU stay, invasive mechanical ventilation, and thrombotic and inflammatory parameters. Results: Data of 720 patients were analyzed, 258 in the prophylaxis group and 462 in the treatment group. C Reactive Protein, invasive mechanical ventilation, tocilizumab and corticosteroid treatments were related with the choice of LMWH dose. Hemorrhagic events (66/720, 9.2%) and thrombotic complications (69/720, 9.6%) were similar in both groups (P=.819 and P=.265), as was the time course of the thrombotic events, earlier than hemorrhagic ones (9 [3-18] and 12 [6-19] days respectively). Mortality was lower in prophylaxis group (25.2% versus 35.1%), but once an inverse probability weighting model was applied, we found no effect of LMWH dose. Conclusion: We found no benefit or harm with the administration of therapeutic or prophylactic LMWH dose in COVID19 critically ill patients. With a similar rate of hemorrhagic or thrombotic events, the LMWH dose had no influence on mortality. More studies are needed to determine the optimal thromboprophylaxis protocol for critically ill patients.

Knowledge, attitudes, and behavior regarding antibiotics, antibiotic use, and antibiotic resistance in students and health care professionals of the district of Barranquilla (Colombia): A cross-sectional survey.

Objective: To evaluate the knowledge, attitudes and behavior regarding antibiotics, use of antibiotics, and antibiotic resistance in students and health care professionals of the district of Barranquilla, Colombia. Study design: Descriptive, cross-sectional. Methods: A sample of 399 respondents was selected, that included health professionals and medical students from 12 health institutions in the district of Barranquilla (Colombia), using an established stratified sampling method. Each of the respondent professionals completed a survey that included 43 items in the Likert scale. A descriptive analysis of the study variables was performed using the software SPSS version 25. Results: Most of the respondents were women (64.4%), aged between 26 and 35 years (47.6%); 28.8% were nurses and 26.1% general practitioners, with ≤10 years of professional experience (63.4%). Overall, the survey revealed that the participants had considerable knowledge about antibiotic use (89.5%-98% correct answers) and the spread of antibiotic resistance (67.4%-89% correct answers). Approximately 74% of the respondents agreed or fully agreed with the questions related to the management of infections and the provision of advice. Conclusions: The present study revealed that most of the health care professionals surveyed had a good knowledge about antibiotic use, although strategies must be developed to strengthen knowledge regarding the spread of antibiotic resistance. Likewise, it is important to identify opportunities for improvement related with access to the guidelines and/or materials necessary to treat infections and to provide advice on antibiotic use and antibiotic resistance.

Influence of the energy concentration and the standardized ileal digestible lysine content of the diet on performance and egg quality of brown-egg laying hens from 18 to 41 weeks of age.

The influence of the energy and the standardized ileal digestible lysine (DLys) content of the diet on egg production and egg quality, was studied in brown-egg laying hens from 18 to 41 wk of age. The experimental design was completely randomized with 10 treatments organized as a 2 × 5 factorial with 2 energy concentrations (2,750 and 2,800 kcal AMEn/kg) and 5 levels of DLys (values varied from 0.66 to 0.78% and 0.67 to 0.79%, for the low and high energy diets, respectively). Each treatment was replicated 10 times (10 hens per replicate). The data were analyzed using the MIXED procedure of SAS with energy concentration and DLys content of the diets as main effects. In addition, the effects of the DLys on the variables studied were partitioned into its lineal and quadratic components. From 18 to 21 wk of age (pre-peak phase), diet composition had limited effects on egg production. From 22 to 41 wk of age (peak phase), however, an increase of 50 kcal AMEn/kg diet increased egg weight (P < 0.05) and tended to improve energy intake (P = 0.083) and feed conversion ratio (P = 0.074). An increase in DLys improved linearly (P < 0.001) egg production, egg weight, egg mass, feed conversion, and energy conversion ratio, and tended to increase BW gain (P = 0.074). Diet composition did not any affect egg quality trait except shell strength that increased linearly (P < 0.05) with increases in the DLys. Cumulatively (18-41 wk of age), egg weight increased (P < 0.05) as the energy and the DLys content of the diet increased. In summary, an increase in energy and DLys content of the diet had limited effects on egg production during the prepeak phase but improved egg production, feed conversion ratio, and BW gain during the peak phase. The data indicate that hens require at least 839 mg DLys/d to maximize egg production in the peak production phase.

Efficacy of psychological interventions for young adults with mild-to-moderate depressive symptoms: A meta-analysis.

BACKGROUND: Psychological interventions are commonly used to treat mild-to-moderate depression, but their efficacy in young adults has not been exhaustively addressed. This meta-analysis aims to establish it in comparison to no treatment, wait-list, usual treatment, passive interventions, and other bona-fide treatments. METHODS: The search was conducted in Scopus, MEDLINE, PsycINFO, ClinicalTrials.gov, the ISRCTN Registry, Cochrane CENTRAL, Clarivate BIOSIS Previews and the METAPSY database, retrieving studies from the start of records to April 2020. Eligibility criteria included samples of 16-30 years experiencing mild-to-moderate depressive symptoms and participating in randomized controlled trials (RCTs), non-RCTs, or pre-post studies measuring depressive symptomatology and featuring psychological treatments. RESULTS: Up to 45 studies met criteria, consisting of 3,947 participants, assessed using the Quality Assessment Tool for Quantitative Studies and their results meta-analyzed assuming random effects. Psychological interventions proved to be efficacious in RCTs compared to no treatment (g = -0.68; 95% CI = -0.87, -0.48) and wait-list (g = -1.04; 95% CI = -1.25, -0.82), while depressive symptoms also improved in pre-post studies (g = -0.99; 95% CI = -1.32, -0.66). However, intervention efficacy was similar to usual care, passive, and bona-fide comparators. The heterogeneity found, a likely reporting bias and the low quality of most studies must be considered when interpreting these results. CONCLUSIONS: Psychological treatments are efficacious to reduce depressive symptoms in young adults, but comparable to other interventions in the mild-to-moderate range. Moderators like depression severity or therapist involvement significantly influenced their efficacy, with results encouraging clinicians to adopt flexible and personalized approaches.

Evaluation of Risk and Preventive Factors for Necrotizing Enterocolitis in Premature Newborns. A Systematic Review of the Literature.

Necrotizing enterocolitis (NEC) is a serious condition related to prematurity and the initiation of enteral feeding. In this article, we review the evidence published in recent years on necrotizing enterocolitis risk factors (prematurity, feeding with low-weight formula, existence of intestinal dysbiosis) and protective factors (human milk or donated milk supply, supplementation of human milk with oligosaccharides, probiotics administration, and the determination of disease predictive biomarkers). A systematic review was conducted of preventive, risk and predictive factors for necrotizing enterocolitis in neonates prior to 37 weeks' gestational age, based on a literature search for clinical trials, meta-analyses, randomized controlled trials and systematic reviews published between January 2018 and October 2021. For this purpose, the PubMed, MEDLINE, and Cochrane Library databases were consulted. The literature search obtained 113 articles, of which 19 were selected for further analysis after applying the inclusion and exclusion criteria. The conclusions drawn from this analysis were that adequate knowledge of risk factors that can be prevented or modified (such as alteration of the intestinal microbiota, oxidative stress, metabolic dysfunction at birth, or alteration of the immunity modulation) can reduce the incidence of NEC in premature infants. These factors include the supplementation of enteral nutrition with human milk oligosaccharides (with prebiotic and immunomodulatory effects), the combined administration of probiotics (especially the Lactobacillus spp and Bifidobacterium spp combination, which inhibits bacterial adhesion effects, improves the intestinal mucosa barrier function, strengthens the innate and adaptive immune system and increases the secretion of bioactive metabolites), the supplementation of human milk with lactoferrin and the use of donated milk fortified in accordance with the characteristics of the premature newborn. The determination of factors that can predict the existence of NEC, such as fecal calprotectin, increased TLR4 activity, and IL6 receptor, can lead to an early diagnosis of NEC. Although further studies should be conducted to determine the values of predictive biomarkers of NEC, and/or the recommended doses and strains of probiotics, lactoferrin or oligosaccharides, the knowledge acquired in recent years is encouraging.

Central Stellated Scar Sign: Classic Imaging Finding of Renal Oncocytoma with Radiopathological Correlation

Oncocytomas are benign tumors, with the classic stellate scar found in up to a third of cases, mainly in large ones. We present the case of a 69-year-old man with a palpable, mobile, and painless mass on the right flank, where abdominal ultrasound and abdominal computed tomography detected the presence of a solid right kidney lesion with a central stellate area in the sinus. Postoperative histological analysis confirmed the presence of oncocytoma with a central stellate scar. Biopsy may not be useful to distinguish this entity from renal carcinoma, surgery being necessary for definitive confirmation of the diagnosis of oncocytoma (AU)

A lower limb rehabilitation platform with mirror therapy, electrical stimulation and virtual reality for people with limited dorsiflexion movement.

This paper presents a low-cost portable system for applying a rehabilitation therapy, based on virtual reality, functional electrical stimulation and a training device. This open-hardware system, intended to support a home-made therapy process in people with reduced dorsiflexion ability, contains three main building blocks: an electromechanical platform, an immersive virtual reality interface and the firmware. The electromechanical training platform is the core of the system, which acts as a gateway interface of sensors-actuators for a closed loop system, through an immersive virtual reality application, the patient closes the loop by acting as the controller by means of a "virtual dummy" preforming in mirror configuration. The platform measures and process the dorsiflexion angle described by both ankles, real-time transmitting the information to the mobile phone virtual application to be presented as a mirror. The onboard microprocessor drives the operation of the electric stimulation interface, which is sent through two channels to both, healthy and affected lower limbs. The platform communicates continuously through a USB bidirectional interface with a personal computer, in which the physician enters the rehabilitation protocol and follows the patient performance. A first case study by using this device has been reported in [1].

Propuesta de un sistema con realidad virtual y electroestimulación para tratar el movimiento de dorsiflexión del tobillo: a propósito de un caso / Virtual reality system with functional electrostimulation to recover ankle dorsiflexion movement: A case study

Antecedentes: Recuperar el movimiento de dorsiflexión es importante para la estabilidad corporal en personas que han sufrido un accidente cerebrovascular (ACV). Diferentes métodos de rehabilitación aplicados presentan resultados satisfactorios en el tratamiento de extremidades afectadas; sin embargo, este trabajo pretende indagar la posibilidad de unificar estas tres técnicas en un solo proceso de rehabilitación destinado a la dorsiflexión del pie. Objetivo: Evaluar el efecto que tiene implementar realidad virtual inmersiva, estimulación eléctrica funcional y rehabilitación por terapia de espejo a un paciente con limitación de marcha causada por un ACV. Métodos: Participante con afectación de movimiento en la extremidad derecha a causa de un ACV al que se le aplica protocolo de rehabilitación con un periodo de 3semanas con intensidad de 5días a la semana y un tiempo de 15min. Se evalúa el progreso en la movilidad de dorsiflexión al inicio, en el intermedio y al final del proceso de rehabilitación. Resultados: El participante genera un progreso en la movilidad de dorsiflexión del 6,75% y mejora la precisión en el movimiento de dorsiflexión que se potencializa en cada sesión de evaluación, lo que supone una mejoría en el control motor y en la estabilidad del equilibrio del paciente. Conclusiones: Se demuestra que la combinación de estos métodos de rehabilitación puede mejorar la movilidad del tobillo en personas que sufren un ACV y, a su vez, la necesidad de ampliar el estudio a una población representativa para consolidar los resultados obtenidos.

Background: Regaining the dorsiflexion movement is important for body stability in people who have suffered a stroke. Different applied rehabilitation methods show satisfactory results in the treatment of affected limbs. However, this work aims to investigate the possibility of unifying these three techniques in a single rehabilitation process aimed at dorsiflexion of the foot. Aim: To evaluate the effect of implementing immersive virtual reality, functional electrical stimulation, and mirror therapy rehabilitation in a patient with gait limitation caused by a stroke. Methods: Participant with movement impairment in the right limb due to stroke, a rehabilitation protocol is applied with a period of 3weeks with intensity of 5days a week and a time of 15min. Progress in dorsiflexion mobility is evaluated at the beginning, in the middle and at the end of the rehabilitation process. Results: The participant generates a 6.75% progress in dorsiflexion mobility, improved precision in the dorsiflexion movement that is potentiated in each evaluation session, which implies an improvement in motor control and in the stability of the patient's balance. Conclusions: It is shown that the combination of these rehabilitation methods can improve ankle mobility in people who suffer a stroke and, in turn, extend the study to a representative population to consolidate the results obtained.

Regional variation in multiple paternity in the brown smooth-hound shark Mustelus henlei from the northeastern Pacific.

Multiple paternity (MP) in the brown smooth-hound shark (Mustelus henlei) was assessed in 15 litters (15 mothers and 97 embryos) collected in the northern Gulf of California of which 86.7% were sired by more than one male (i.e., from 2 to 4 sires). When taken together with results from previous studies, this record indicates that there is regional variation in MP in M. henlei in the northeastern Pacific. This pattern is associated with variations in the reproductive traits of each population (e.g., female size and litter size). In the Gulf of California, the results of a generalized linear model (GLZ) indicated that the litters of larger females had a higher probability of MP compared to those of smaller females.

Factores predictivos de mortalidad e ingreso en la unidad de cuidados intensivos en pacientes con pielonefritis enfisematosa: experiencia de 5 años en un hospital terciario / Predictive factors for mortality and intensive care unit admission in patients with emphysematous pyelonephritis: 5-year experience in a tertiary care hospital

Introduction and objectivesEmphysematous pyelonephritis is a life-threatening infection of the kidney and surrounding tissues associated with a high mortality rate. The aim of this study was to determine predictive factors for mortality and intensive care unit admission in patients with emphysematous pyelonephritis, and to propose a therapeutic algorithm based on current literature and our experience.MethodsA retrospective study was done including patients with emphysematous pyelonephritis in a single center in the north of Mexico from 2011-2016. Demographic, clinical, microbiological and biochemical parameters, therapeutic management, and outcomes were assessed. Factors associated with admission to intensive care unit and mortality were determined. Comparison was assessed using χ2 test for categorical variables, and T-test for numerical variables. Univariate and multivariate logistic regression analyses were performed. Statistical significance was set at p<0.05.ResultsA total of 63 patients were included, of which 55(87.3%) were females, with a mean age of 55.5±12.2 years. The most common comorbidities were diabetes and hypertension. Escherichia coli was the most common isolated microorganism (51.7%) and extended-spectrum beta-lactamase-producing agents were reported in 31.7%. Conservative therapy was provided to 38.7%, double J stent 42.9%, open/percutaneous drainage 12.7%, and nephrectomy 25.3%. Overall mortality and intensive care admission were 20.6% and 36.5%, respectively. In the multivariate analysis, hemodynamic instability (p=0.005), qSOFA≥2 (p=0.003), hypoalbuminemia (p=0.02), and early nephrectomy (p=0.002) were associated with intensive care admission. Huang scale 4 (p=0.006) and early nephrectomy (p=0.001) were associated to mortality.ConclusionsEmphysematous pyelonephritis is a life-threatening disease and evidence of management is based in small case series due to the low incidence of this condition.

Introducción y objetivosLa pielonefritis enfisematosa es una infección del riñón y los tejidos circundantes que pone en riesgo la vida del paciente y se asocia a una elevada tasa de mortalidad. El objetivo de este estudio fue determinar los factores predictivos de mortalidad e ingreso en la unidad de cuidados intensivos en pacientes con pielonefritis enfisematosa, y proponer un algoritmo terapéutico basado en la literatura actual y en nuestra experiencia.MétodosSe realizó un estudio retrospectivo incluyendo los pacientes con pielonefritis enfisematosa en un solo centro del norte de México entre 2011 y 2016. Se evaluaron parámetros demográficos, clínicos, microbiológicos y bioquímicos, el manejo terapéutico y los resultados. Se determinaron los factores asociados con el ingreso a la unidad de cuidados intensivos y la mortalidad. La comparación se evaluó mediante la prueba de chi cuadrado para las variables categóricas, y la prueba t de Student para las variables numéricas. Se realizaron análisis de regresión logística univariante y multivariante. La significación estadística se fijó en p<0,05.ResultadosSe incluyeron 63 pacientes, de los cuales 55 (87,3%) eran mujeres, con una edad media de 55,5±12,2 años. Las comorbilidades más frecuentes fueron la diabetes y la hipertensión. Escherichia coli fue el microorganismo más comúnmente aislado (51,7%) y los agentes productores de betalactamasas de espectro extendido se registraron en el 31,7%. Se administró tratamiento conservador al 38,7%, el uso de catéter doble J en el 42,9%, drenaje abierto/percutáneo en el 12,7% y nefrectomía en el 25,3%. La mortalidad global y el ingreso en cuidados intensivos fueron del 20,6% y el 36,5%, respectivamente. En el análisis multivariante, la inestabilidad hemodinámica (p=0,005), la escala qSOFA≥2 (p=0,003), la hipoalbuminemia (p=0,02) y la nefrectomía temprana (p=0,002) se asociaron con el ingreso en cuidados intensivo