Clinical-haematological changes and predictors of severity in acute food protein-induced enterocolitis syndrome reactions at oral food challenge: a multicentre observational study.

BACKGROUND: Oral food challenge (OFC) is the gold standard for diagnosis of acute Food Protein-Induced Enterocolitis Syndrome (FPIES). No diagnostic/prognostic biomarkers are available, and OFC assessment criteria are not validated. OBJECTIVE: To assess clinical-haematological changes and predictors of severity of FPIES reactions at OFC. METHODS: Observational multicentre prospective study. Children aged 0-18 years diagnosed with acute FPIES were recruited at follow-up OFC in 12 tertiary centres in Spain and Italy. OFC Outcomes (as positive/negative/inconclusive and mild/moderate/severe) were assessed based on published '2017 FPIES Consensus' criteria. Clinical characteristics were recorded, and full blood count was done at baseline, reaction onset and 4 hours later. Regression analysis was performed to assess predictors of severe reactions at OFC. RESULTS: 81 children had positive OFC (mild in 11% (9/81), moderate in 61% (49/81), severe in 28% (23/81)). Increase in neutrophils and reduction in eosinophils, basophils and lymphocytes was observed (P-value<0.05). OFC was inconclusive in 19 cases despite objective signs or neutrophilia. Regression analysis showed a 2-day OFC protocol where only 25% of an age-appropriate portion is given on day 1 (not gender, age, culprit food, cumulative dose and previous reaction severity) was associated with reduced odds of severe reaction compared to giving multiple doses in a single day. CONCLUSION: Distinct haematological changes may help support FPIES diagnosis. Current OFC assessment criteria may not capture the broad spectrum of acute FPIES presentations. This 2-day protocol may associate a reduced risk of severe reactions. Future work should aim to develop safer OFC and non-OFC diagnostics for FPIES.

Universal pre-mixing dry-film stickers capable of retrofitting existing microfluidics.

Integrating microfluidic mixers into lab-on-a-chip devices remains challenging yet important for numerous applications including dilutions, extractions, addition of reagents or drugs, and particle synthesis. High-efficiency mixers utilize large or intricate geometries that are difficult to manufacture and co-implement with lab-on-a-chip processes, leading to cumbersome two-chip solutions. We present a universal dry-film microfluidic mixing sticker that can retrofit pre-existing microfluidics and maintain high mixing performance over a range of Reynolds numbers and input mixing ratios. To attach our pre-mixing sticker module, remove the backing material and press the sticker onto an existing microfluidic/substrate. Our innovation centers around the multilayer use of laser-cut commercially available silicone-adhesive-coated polymer sheets as microfluidic layers to create geometrically complex, easy to assemble designs that can be adhered to a variety of surfaces, namely, existing microfluidic devices. Our approach enabled us to assemble the traditional yet difficult to manufacture "F-mixer" in minutes and conceptually extend this design to create a novel space-saving spiral F-mixer. Computational fluid dynamic simulations and experimental results confirmed that both designs maintained high performance for 0.1 < Re < 10 and disparate input mixing ratios of 1:10. We tested the integration of our system by using the pre-mixer to fluorescently tag proteins encapsulated in an existing microfluidic. When integrated with another microfluidic, our pre-mixing sticker successfully combined primary and secondary antibodies to fluorescently tag micropatterned proteins with high spatial uniformity, unlike a traditional pre-mixing "T-mixer" sticker. Given the ease of this technology, we anticipate numerous applications for point-of-care devices, microphysiological-systems-on-a-chip, and microfluidic-based biomedical research.

Objective evaluation of the ``scratch collapse test'' for the diagnosis of carpal tunnel syndrome.

PURPOSE: Evaluate the Scratch Collapse Test in an objective way, by replacing the subjective evaluation made by the physician with an objective evaluation measure, made with a digital dynamometer. METHODS: Observational study carried out, in 90 patients divided into three groups of 30 patients, taking into account the electromyographic study of the median nerve in the carpal tunnel (no alteration, moderate, severe).The external rotation of the shoulder was measured in four different situations (no scratch, scratch over the carpal tunnel, scratch in the dorsum of the wrist and scratch in the shoulder). RESULTS: There were no statistical differences in the result of the strength in any of the four different situations in patients without carpal tunnel of with moderate carpal tunnel syndrome. However, there were statistical differences between the basal measurement (without scratching) and the measurement after tunnel scratching in patients with severe carpal tunnel syndrome. But this statistical difference was only 0.08 kg in the average measure, and this difference is clinically undetectable and far for producing a real collapse of the external rotation of the shoulder. CONCLUSION: The Scratch Collapse Test is not a valid diagnostic exam for carpal tunnel syndrome if the strength is measured in an objective manner.

COVID-19: Initial experience of an international group of hand surgeons.

The emergence of the COVID-19 pandemic has severely affected medical treatment protocols throughout the world. While the pandemic does not affect hand surgeons at first glance, they have a role to play. The purpose of this study was to describe the different measures that have been put in place in response to the COVID-19 pandemic by hand surgeons throughout the world. The survey comprised 47 surgeons working in 34 countries who responded to an online questionnaire. We found that the protocols varied in terms of visitors, health professionals in the operating room, patient waiting areas, wards and emergency rooms. Based on these preliminary findings, an international consensus on hand surgery practices for the current viral pandemic, and future ones, needs to be built rapidly.

Prevalencia del virus de la rinotraqueitis infecciosa bovina en el departamento del Caquetá, Amazonía Colombiana / Prevalence of bovine infectious rhinotracheitis virus in Caquetá department, Colombian Amazon

RESUMEN La rinotraqueitis infecciosa bovina (IBR) es una enfermedad ampliamente difundida en el mundo con gran repercusión socio-económica en las ganaderías bovinas. El objetivo del presente estudio fue determinar la prevalencia de IBR en 100 hatos del departamento del Caquetá, para lo cual, se muestrearon 960 bovinos mayores de 36 meses entre enero y marzo de 2016 en predios seleccionados a partir de los criterios: a) tamaño (50-180 hectáreas), b) con más de 10 vacas en ordeño, c) disponibilidad de los productores para cooperar y d) accesibilidad de las vías. Las muestras de suero sanguíneo se remitieron al Laboratorio de Diagnóstico Clínico Veterinario del ICA y se analizaron a través la prueba Elisa de bloqueo (BHV-1) gB. Los sueros con porcentaje de bloqueo superior al 55% se consideraron positivos a anticuerpos para IBR. Se encontró alta seroprevalencia (73,13%), mayor además en machos que en hembras (p < 0,05). A nivel municipal la seroprevalencia fue mayor en los municipios de El Doncello, Puerto Rico y San Vicente del Caguán y se encontró diferencia significativa (p < 0,05) entre los nueve municipios analizados. A nivel de hatos, la prevalencia fue del 99%. En conclusión, la prevalencia del virus de la rinotraqueitis infecciosa bovina (IBR) en bovinos de doble propósito del departamento del Caquetá fue muy alta.

ABSTRACT Infectious bovine rhinotracheitis (IBR) is a disease widely spread throughout the world with great socio-economic impact on bovine livestock. The objective of this study was to determine the prevalence of IBR in 100 herds in Caqueta department, for which 960 cattle older than 36 months between January and March 2016 were sampled in farms selected from the criteria: a) size (50-180 hectares), b) with more than 10 cows in milking, c) availability of producers to cooperate and d) accessibility of roads. Blood serum samples were sent to the ICA veterinary clinical diagnostic laboratory and analyzed using the Elisa blocking test (BHV-1) gB, where sera with blocking percentage greater than 55% were considered as positive for IBR antibodies. High seroprevalence was found (73.13%), being higher in males than in females (p < 0.05). At municipal level, seroprevalence was greater in El Doncello, Puerto Rico and San Vicente del Caguán municipalities, significant difference (p<0.05) was found between the nine municipalities analyzed. At herd level prevalence was of 99%. In conclusion the prevalence of Infectious Bovine Rhinotracheitis (IBR) virus in dual-purpose cattle of Caquetá department was very high.

Ventilation time and prognosis after stroke thrombectomy: the shorter, the better!

BACKGROUND AND PURPOSE: The aim was to investigate the clinical impact of the duration of artificial ventilation in stroke patients receiving mechanical thrombectomy (MT) under general anaesthesia. METHODS: All consecutive ischaemic stroke patients who had been treated at our centre with MT for anterior circulation large vessel occlusion under general anaesthesia were identified over an 8-year period. Ventilation time was analysed as a continuous variable and patients were grouped into extubation within 6 h ('early'), 6-24 h ('delayed') and >24 h ('late'). Favourable outcome was defined as modified Rankin Scale scores of 0-2 at 3 months post-stroke. Pneumonia rate and reasons for prolonged ventilation were also assessed. RESULTS: Amongst 447 MT patients (mean age 69.1 ± 13.3 years, 50.1% female), the median ventilation time was 3 h. 188 (42.6%) patients had a favourable 3-month outcome, which correlated with shorter ventilation time (Spearman's rho 0.39, P < 0.001). In patients extubated within 24 h, early compared to delayed extubation was associated with improved outcome (odds ratio 2.40, 95% confidence interval 1.53-3.76, P < 0.001). This was confirmed in multivariable analysis (P = 0.01). A longer ventilation time was associated with a higher rate of pneumonia during neurointensive care unit/stroke unit stay (early/delayed/late extubation: 9.6%/20.6%/27.7%, P < 0.01). Whilst stroke-associated complications represented the most common reasons for late extubation (>24 h), delayed extubation (6-24 h) was associated with admission outside of core working hours (P < 0.001). CONCLUSIONS: Prolonged ventilation time after stroke thrombectomy independently predicts unfavourable outcome at 3 months and is associated with increased pneumonia rates. Therefore, extubation should be performed as early as safely possible.

Incidencia de enfermedad pulmonar obstructiva crónica en pacientes con el virus de la inmunodeficiencia humana. Análisis post-hoc del estudio viva / Incidence of chronic obstructive pulmonary disease in patients with human immunodeficiency virus. Post-hoc analysis of the viva study

Introducción: desde la aparición de la terapia antiretroviral la supervivencia de los pacientes infectados por el virus de la inmunodeficiencia humana (VIH) ha aumentado considerablemente tomando importancia la aparición de otras patologías crónicas en estos pacientes como puede ser la enfermedad pulmonar obstructiva crónica (EPOC). Nuestro objetivo fue conocer la incidencia de EPOC en una cohorte de pacientes VIH derivados en un programa de detección de hipertensión pulmonar (HTP). Material y Métodos: análisis post-hoc, de un prospectivo, pseudo-experimental de pacientes con infección del VIH a los que se les preguntaba por disnea y en caso afirmativo eran derivados a consultas de neumología para despistaje de HTP. Resultado: desde 2014 hasta 2016, reclutamos un total de 32 pacientes, con un predominio de varones (75%). La disnea según la mMRC (Medical Reserach Council) fue grado 1, 2 y 3 en el 37,5%, 43,8% y 18,8%, respectivamente. La prevalencia de tabaquismo fue del 87,1% (intervalo de confianza [IC] 95%: 71- 96,4%), y 18 pacientes fueron catalogados de EPOC (62%; IC95%: 42,2 - 79,3%). Conclusión: la incidencia de EPOC en nuestra serie fue muy superior a la de la población general. Es necesario plantear estrategias de búsqueda activa de EPOC en estos pacientes para un diagnóstico y tratamiento precoz

Introduction: Since the advent of antiretroviral therapy, the survival of patients infected with the human immunodeficiency virus (HIV) has considerably increased, with the occurrence of other chronic diseases such as chronic obstructive pulmonary disease (COPD) gaining importance in these patients. Our objective was to find out the incidence of COPD in a cohort of HIV patients that were referred to a program to detect pulmonary hypertension (PH). Materials and Methods: Post hoc analysis of a prospective, quasi-experimental study on HIV-infected patients who were asked whether they had dyspnea. If this was the case, they were referred to a pulmonologist for PH screening. Results: From 2014 to 2016, we recruited a total of 32 patients, with a predominance of male recruits (75%). According to the mMRC (Modified Medical Research Council) Dyspnea Scale, 37.5%, 43.8% and 18.8% were classified as Grade 1, 2 and 3, respectively. The prevalence of smoking was 87.1% (95% confidence interval [CI]: 71 - 96.4%), and 18 patients were classified with COPD (62%; 95% CI: 42.2 - 79.3%). Conclusion: The incidence of COPD in our sample was much higher than that of the general population. It is necessary to plan active search strategies for COPD in these patients for early diagnosis and treatment

Bloqueo auriculoventricular inducido por el ejercicio: no tan infrecuente para ser ignorado / Exercise-induced atrioventricular block: not so uncommon to be ignored

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Ventilator autotriggering : An underestimated phenomenon in the determination of brain death.

BACKGROUND: Ventilator autotriggering (VAT) may induce uncertainty in diagnosing brain death because it may falsely suggest a central respiratory drive in brain-dead patients where no intrinsic respiratory efforts exist. Since the lack of international standardization of brain death criteria contributes to the loss of potential donor organs, it is important to be aware of this phenomenon, which is a not well-known confounder in the process of diagnosing brain death. METHODS: The national official recommendations or guidelines for the determination of brain death and organ transplantation of 15 selected European countries (including all 8 member states of the Eurotransplant network) were evaluated with respect to VAT. In addition, a literature search (PubMed, Google Scholar) using the term "ventilator autotriggering", synonyms or similar content-related wording was carried out. RESULTS: The VAT phenomenon was mentioned in 3 of the 15 official recommendations and guidelines on diagnosing brain death. The causes and management of VAT are presented in different ways in the reviewed official recommendations and guidelines. CONCLUSION: The phenomenon of VAT is inconsistently addressed in the national guidelines and recommendations for the determination of brain death and should, therefore, be included in future harmonized brain death codes. Detection and correction of VAT should be implemented as early as possible by a structured procedure. Additional training and information on this phenomenon should be made available to the entire intensive care unit staff.

Maternal grazing on stubble and Mediterranean shrubland improves meat lipid profile in light lambs fed on concentrates.

Concentrates-fed lamb meat is often associated with an unfavourable lipid profile (high levels of saturated and/or n-6 polyunsaturated fatty acids; SFA and PUFA). For this reason, Spanish sheep producers from Mediterranean areas are turning to traditional grazing by ewes to obtain healthier lamb meat. The objective of this research was to determine the effects of maternal grazing on the fatty acid (FA) composition of weaned lamb meat. The ewes (Segureña breed) were allocated to two different rearing systems during pregnancy (5 months) and lactation (45 days): (i) feeding indoors on barley grain and lucerne pellets; (ii) grazing on cereal stubble, fallow land and seasonal pastures consisting of Mediterranean shrubs, herbs and trees. Two groups of 20 autumn and spring lambs were sampled. The lambs were weaned at 13.1±0.9 kg and 45.0±4.1 days age and fed on grain-based concentrates until they reached 24.8±2.1 kg live weight (light lambs slaughtered at 98.3±3.6 days of age). The FA content was determined in the intramuscular loin fat by gas chromatography using a flame ionization detector. The ewe diet did not affect the levels of the main lamb FAs (C18:1c+t, C16:0 and C18:2c), and so did not provide any additional reduction in fat saturation. Saturated fatty acids represented around 40% of total FAs determined in the meat. Ewe grazing acted as an n-3 PUFA-promoting diet, providing a lamb meat with a lower n-6/n-3 ratio. Spring lamb meat had higher proportions of n-3 PUFA (C18:3n-3, C20:5, C22:5 and C22:6) and conjugated linoleic acid (C18:2c9t11+c11t9) to the detriment of the n-6 PUFAs (C20:4, C20:2 and C22:4), while autumn lamb meat also had higher levels of C18:3n-3 and C18:3n-6, and lower level of C20:4, which points to little seasonal differences. The n-6/n-3 ratio achieved by ewe grazing fell from 8.2 to 4.1 (Spring) and from 7.6 to 5.5 (Autumn), values which are close to those recommended in human diet for good cardiovascular health. These n-6/n-3 reductions were associated with lower levels of total PUFA and C20:4n-6. Our research concluded that grazing on stubble and Mediterranean shrubland by ewes, a sustainable rearing practice involving local agro resources, contributed to obtaining weaned lamb meat with a more favourable lipid profile and so can be recommended to sheep farmers.

Tolerability and immunological effect of short up-dosing immunotherapy with 2 standardized native allergen extracts derived from the pollen of Salsola kali and Cupressus arizonica

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Assessment of enlarged perivascular spaces and their relation to target organ damage and mild cognitive impairment in patients with hypertension.

BACKGROUND AND PURPOSE: Enlarged perivascular spaces (EPVS) have been recently considered a feature of cerebral small vessel disease. They have been related to aging, hypertension and dementia but their relationship with hypertension related variables (i.e. target organ damage, treatment compliance) and mild cognitive impairment (MCI) is not fully elucidated. Our aims were to investigate the relation between basal ganglia (BG) and centrum semiovale (CSO) EPVS with vascular risk factors, hypertension related variables and MCI. METHODS: In all, 733 hypertensive individuals free of stroke and dementia from the Investigating Silent Strokes in Hypertensives, a magnetic resonance imaging Study (ISSYS) underwent brain magnetic resonance imaging and cognitive testing to diagnose MCI or normal cognitive aging. RESULTS: The numbers of participants presenting high grade (>10) EPVS at the BG and CSO were 23.3% and 40.0%, respectively. After controlling for vascular risk factors, high grade BG EPVS were associated with age (odds ratio 1.68; 95% confidence interval 1.37, 2.06), poor antihypertensive compliance (1.49; 1.03, 2.14) and the presence of microalbuminuria (1.95; 1.16, 3.28), whereas in the CSO only age (1.38; 1.18, 1.63) and male sex were associated with EPVS (1.73; 1. 24, 2.42). MCI was diagnosed in 9.3% of the participants and it was predicted by EPVS in the BG (1.87; 1.03, 3.39) but not in the CSO. This last association was greatly attenuated after correction for lacunes and white matter hyperintensities. CONCLUSIONS: Basal ganglia EPVS are associated with the presence of microalbuminuria and poor adherence to antihypertensive drugs. The BG EPVS relation with MCI is not independent of the presence of other cerebral small vessel disease markers.

Blood and CSF biomarkers in brain subcortical ischemic vascular disease: Involved pathways and clinical applicability.

Vascular dementia is the second most common type of dementia after Alzheimer's disease (AD). Subcortical ischemic vascular disease refers to a form of vascular cognitive impairment characterized by the presence of diffuse white matter hyperintensities (WMHs) and multiple lacunar infarcts. These neuroimaging findings are mainly caused by cerebral small-vessel disease (cSVD) and relate to aging and cognitive impairment, but they can also be silent and highly prevalent in otherwise healthy individuals. We aimed to review studies on blood and cerebrospinal fluid (CSF) markers related to the presence of WMHs and lacunar infarcts that have been conducted in the past in large population-based studies and in high-risk selected patients (such as those with vascular risk factors, vascular cognitive impairment, or AD). Relevant associations with the presence and progression of cSVD have been described in the blood for markers related to inflammatory processes, endothelial damage and coagulation/fibrinolysis processes, etc. Also, different combinations of CSF markers might help to differentiate between etiologic types of dementia. In the future, to translate these findings into clinical practice and use biomarkers to early diagnosis and monitoring vascular cognitive impairment would require the replication of candidate markers in large-scale, multicenter, and prospectively designed studies.

La educación física y el deporte en las universidades laborales / Physical education and sport in vocational universities

Este estudio aborda las características de la Educación Física y el deporte en las Universidades Laborales. Para ello, desde una perspectiva histórica, se han analizado diversas fuentes primarias (documentales, gráficas y jurídicas). Las conclusiones obtenidas señalan que, inicialmente, la Educación Física y el deporte fueron entendidos como instrumentos adoctrinadores al servicio del modelo social que trataba de ser impuesto por el Régimen. Sin embargo, esta orientación inicial rápidamente fue perdiendo vigor en favor de aspectos propiamente deportivos, que eran consecuencia directa de la política iniciada por Elola Olaso a nivel nacional. De hecho, las Universidades Laborales llegaron a ser, en el ámbito de los centros educativos, referentes nacionales a nivel deportivo (AU)

This paper discusses the characteristics of Physical Education and sport in Vocational Universities. For this purpose, from a historical perspective, we have analyzed various primary sources (documentary, graphic and legal). The conclusions indicate that, initially, Physical Education and Sport were understood as indoctrinating instruments at the service of the social model that was imposed by the Regime. However, this initial orientation changed quickly in favour of sport aspects, which were a direct result of the national policy initiated by Elola Olaso. In fact, Vocational Universities became important national centers at sport level (AU)

Phase II/III clinical trial to assess the tolerability and immunological effect of a new updosing phase of Dermatophagoides mix-based immunotherapy.

BACKGROUND: Immunologically enhanced subcutaneous specific immunotherapy (SCIT) has been developed with a fast and simplified updosing phase containing equal parts of the house dust mites (HDM) Dermatophagoides pteronyssinus and Dermatophagoides farinae (Dermatophagoides mix) adsorbed on aluminum hydroxide. OBJECTIVE: To evaluate the tolerability and immunological impact of the updosing phase of this new allergen extract formulation. MATERIAL AND METHODS: We performed a multicenter, open-label, single-arm, phase II/III clinical trial. The inclusion criteria were a clinical history of rhinitis/conjunctivitis due to HDM (with/without asthma) and sensitization to HDM (positive specific IgE and skin prick test). Five updosing injections of Dermatophagoides mix (300, 600, 3000, 6000, and 15000 SQ+) were administered at weekly intervals with 1 maintenance injection (15000 SQ+) 2 weeks after the last updosing injection. Two days after each visit, patients were contacted by telephone to follow up on any adverse events. IgE-blocking factor, IgG4, and immediate skin reactivity were evaluated. RESULTS: The sample comprised 102 patients (mean [SD] age, 29.3 [7.7] years; male, 52.9%). There were 117 adverse drug reactions (ADR): 101 were local, regardless of reaction size, in 48 (47.1%) patients and 7 were systemic (all grade I) in 5 (4.9%) patients. All ADRs were mild, except for 1, which was moderate. Six weeks of treatment led to statistically significant increases in IgE-blocking factor and IgG4, as well as a significant reduction in immediate skin reactivity. CONCLUSION: This new updosing phase of Dermatophagoides mix-based immunotherapy had a good tolerability profile and induced a significant immunological effect.

New limits on intrinsic charm in the nucleon from global analysis of parton distributions.

We present a new global QCD analysis of parton distribution functions, allowing for possible intrinsic charm (IC) contributions in the nucleon inspired by light-front models. The analysis makes use of the full range of available high-energy scattering data for Q^{2}≳1 GeV^{2} and W^{2}≳3.5 GeV^{2}, including fixed-target proton and deuteron cross sections at lower energies that were excluded in previous global analyses. The expanded data set places more stringent constraints on the momentum carried by IC, with ⟨x⟩_{IC} at most 0.5% (corresponding to an IC normalization of ∼1%) at the 4σ level for Δχ^{2}=1. We also critically assess the impact of older EMC measurements of F_{2}^{c} at large x, which favor a nonzero IC, but with very large χ^{2} values.