Clinical features and immune mechanisms directly linked to the altered liver function in patients with rheumatoid arthritis.

BACKGROUND: The aim of this study was to explore the impact of arthritis on liver function using different approaches in vivo and in vitro. METHODS: A cross-sectional study was performed on 330 non-obese/non-T2DM subjects: 180 RA patients, 50 NAFLD non-RA patients, and 100 healthy donors (HDs). A longitudinal study was conducted on 50 RA patients treated with methotrexate for six months. Clinical and laboratory parameters and markers of liver disease were collected. Mechanistic studies were carried out in both the CIA mouse model and hepatocytes treated with anti-citrullinated protein antibodies (ACPAs). RESULTS: RA patients have an increased risk of suffering from liver disease independent of obesity or T2DM. This risk was associated with factors such as insulin resistance, autoantibodies, inflammation, and component C3. Methotrexate treatment for six months was associated with liver abnormalities in those newly-diagnosed patients having CV risk factors. ACPAs induced a defective hepatocyte function, promoting IR and inflammation. The induction of arthritis in mice caused the infiltration of immune cells in the liver and increased inflammatory, apoptotic, and fibrotic processes. CONCLUSION: RA patients may experience mild to moderate liver inflammation due to the infiltration of T, B cells, and macrophages, and the action of ACPAs. This is independent of obesity or diabetes and linked to systemic inflammation, and disease activity levels. The negative effects of methotrexate on liver function could be restricted to the concomitant presence of cardiovascular risk factors.

Balón de resucitación aórtico endovascular (REBOA) para el control de la hemorragia no compresible de torso. Revisión de la evidencia

La hemorragia no compresible de torso continúa siendo unas de las principales causas de mortalidad del paciente víctima de trauma. El control de este tipo de sangrado requiere de procedimientos invasivos como la toracotomía de reanimación, la cual se realiza en el paciente in extremis. La utilización de REBOA se re-introduce desde el 2011, como una forma de oclusión endovascular de la aorta y con el tiempo ya forma parte de los implementos con que cuenta un centro de trauma nivel I. Actualmente REBOA se utiliza dentro del proceso de reanimación, mientras se realiza el control definitivo de un sangrado en el torso, con el fin de aumentar la perfusión de órganos como cerebro y corazón, existiendo dos zonas principales de oclusión a nivel aórtico. Múltiples investigaciones se han realizado para encontrar las indicaciones y beneficios de REBOA dentro de la atención integral de un paciente con trauma grave, estando aun estas en desarrollo. La utilización en un paciente con trauma grave se encuentra protocolizada en diferentes pasos que van desde el acceso arterial hasta el seguimiento de la extremidad post retiro del introductor. Por este último punto, REBOA se encuentra dentro de los implementos importantes de la reanimación, sin embargo, no reemplaza conceptos básicos como atención integral del paciente politraumatizado, control precoz del sangrado y el control de daños resucitativo. Su implementación requiere de un centro altamente protocolizado y con equipos de trauma establecidos con el objetivo de disminuir las complicaciones y optimizar la supervivencia.

Non compressible torso hemorrhage continues to be one of the main causes of mortality in trauma victims. The control of this type of bleeding requires invasive procedures such as resuscitation thoracotomy, that is performed on the patient "in extremis". The use of REBOA has been reintroduced since 2011, as a form of endovascular occlusion of the aorta and over time it is has already part of the implements that a level I trauma center. REBOA is used within the resuscitation process, while definitive control of bleeding in the torso is carried out, in order to increase the perfusion of organs such as the brain and heart, with two main areas of occlusion at the aortic level. Multiple investigations have been carried out to find the indications and benefits of REBOA within the comprehensive care of a patient with severe trauma, and these are still under development. Its use in a patient with severe trauma is protocolized in different steps that go from arterial access to follow-up of the extremity after removal of the sheath. For this last point, REBOA is among the important implements of resuscitation, however, it does not replace basic concepts such as comprehensive care of the polytraumatized patient, early control of bleeding and resuscitative damage control. Its implementation requires a highly protocolized center with established trauma teams with the aim of reducing complications and optimizing survival.

Extrauterine leiomyomatosis, the great mimicker.

OBJECTIVES: Describe the radiographic features of the different forms of extrauterine leiomyomatosis. CONCLUSIONS: Leiomyomas with a rare growth pattern occur most often in women of reproductive age and with a history of hysterectomy. Extrauterine leiomyomas present a greater diagnostic challenge because they may mimic malignancies, and serious diagnostic errors may result.

Leiomiomatosis extrauterina, la gran simuladora / Extrauterine leiomyomatosis, the great mimicker

Objetivos: Definir el concepto de leiomiomatosis extrauterina y describir sus formas de aparición. Realizar una revisión de los hallazgos radiológicos de los distintos tipos de leiomiomatosis extrauterina a partir de casos de nuestro centro. Conclusiones: La leiomiomatosis extrauterina es una entidad rara, típica de mujeres premenopáusicas histerectomizadas. Conocer los hallazgos radiológicos de esta patología permite incluirla en el diagnóstico diferencial de una masa pélvica, una enfermedad peritoneal o una invasión vascular de aspecto tumoral.(AU)

Objectives Describe the radiographic features of the different forms of extrauterine leiomyomatosis. Conclusions: Leiomyomas with a rare growth pattern occur most often in women of reproductive age and with a history of hysterectomy. Extrauterine leiomyomas present a greater diagnostic challenge because they may mimic malignancies, and serious diagnostic errors may result.(AU)

Tumor fibroso solitario (TFS) parafaríngeo: reporte de caso y revisión de literatura / Parapharyngeal solitary fibrous tumor (SFT): case report and literature review

El espacio parafaríngeo es una región donde puede surgir un amplio espectro de tumores, que son poco frecuentes y comprenden solo el 0,5 al 1,5% de las neoplasias de cabeza y cuello. Generalmente, son hallazgos y suelen presentarse como masas asintomáticas. Incluye neoplasias primarias, extensión directa de regiones adyacentes y enfermedad metastásica. La literatura describe múltiples patologías e histologías que pueden surgir de esta zona, entre ellas, tenemos los tumores fibrosos solitarios, que son un espectro de neoplasias mesenquimatosas fibroblásticas de histogénesis incierta, que generalmente involucran la pleura. Son lesiones muy poco frecuentes y su localización parafaríngea es excepcional, siendo su primer reporte en la literatura en 1993. Se presenta el caso de un tumor fibroso solitario del espacio parafaríngeo evaluado en nuestro centro, con su enfrentamiento diagnóstico, resolución quirúrgica y seguimiento respectivo, con el objetivo de presentar esta patología poco frecuente a nuestros colegas y contribuir al conocimiento médico.

The parapharyngeal space is a region where a wide spectrum of tumors can arise, which are rare and comprise only 0.5% to 1.5% of head and neck neoplasms. They are generally findings and usually present as asymptomatic masses. Includes primary neoplasms, direct extension from adjacent regions, and metastatic disease. The literature describes multiple pathologies and histologies that can arise from this area, among them, we have solitary fibrous tumors, which are a spectrum of fibroblastic mesenchymal neoplasms of uncertain histogenesis, which are generally the pleura. It is a very rare lesion and its parapharyngeal location is exceptional, being its first report in the literature in 1993. We present the case of a solitary fibrous tumor of the parapharyngeal space evaluated in our center, with its diagnos- tic confrontation, surgical resolution and respective follow-up, with the aim of presenting this rare pathology to our colleagues and contributing to medical knowledge.

Splicing machinery is profoundly altered in systemic lupus erythematosus and antiphospholipid syndrome and directly linked to key clinical features.

OBJECTIVES: To characterize the splicing machinery (SM) of leukocytes from primary antiphospholipid syndrome (APS), systemic lupus erythematosus (SLE) and antiphospholipid syndrome with lupus (APS + SLE) patients, and to assess its clinical involvement. METHODS: Monocytes, lymphocytes and neutrophils from 80 patients (22 APS, 35 SLE and 23 APS + SLE) and 50 HD were purified, and 45 selected SM components were evaluated by qPCR-microfluidic array. Relationship with clinical features and underlying regulatory mechanisms were assessed. RESULTS: APS, SLE and APS + SLE leukocytes displayed significant and specific alterations in SM-components (SMC), associated with clinical features [autoimmune profiles, disease activity, lupus nephritis (LN), and CV-risk markers]. A remarkable relationship among dysregulated SMC in monocytes and the presence of LN in SLE was highlighted, revealing a novel pathological mechanism, which was further explored. Immunohistology analysis of renal biopsies highlighted the pathological role of the myeloid compartment in LN. Transcriptomic analysis of monocytes from SLE-LN(+) vs SLE-LN(-) identified 271 genes differentially expressed, mainly involved in inflammation and IFN-signaling. Levels of IFN-related genes correlated with those of SMC in SLE-LN(+). These results were validated in two external SLE-LN(+) datasets of whole-blood and kidney biopsies. In vitro, SLE-LN(+)-serum promoted a concomitant dysregulation of both, the IFN signature and several SMC, further reversed by JAKinibs treatment. Interestingly, IFNs, key inflammatory cytokines in SLE pathology, also altered SMC. Lastly, the over/down-expression of selected SMC in SLE-monocytes reduced the release of inflammatory cytokines and their adhesion capacity. CONCLUSION: Overall, we have identified, for the first time, a specific alteration of SMC in leukocytes from APS, SLE and APS + SLE patients that would be responsible for the development of distinctive clinical profiles.

Abdominal tumors in patients with neurofibromatosis type I: Genotype-phenotype relationships.

BACKGROUND: Gastrointestinal stromal tumors have been detected in 25% of the necropsies performed on NF1 patients, but have been reported only in 7% of NF1 patients in the largest series. Such data imply an important gap between the true presence of tumors and those diagnosed. Few genotype-phenotype relationships have been described but to date none referring to abdominal tumors. OBJECTIVES: Evaluate retrospectively the efficacy of a regular and proactive follow-up of NF1 patients to early diagnose abdominal tumors and report their mutations. METHODS: Cohort study performed between 2010 and 2020, with 43 NF1 adult patients followed at our Dermatology department. RESULTS: Eight abdominal tumors were diagnosed in six patients, meaning that 14% of the followed patients developed an abdominal tumor. Five patients (83%) were asymptomatic. Five (83.3%) had a family history of NF1 with abdominal tumors (patients 1,2 and 3,4,5 were relatives). CONCLUSIONS: Although currently gastrointestinal routine screening investigations for asymptomatic patients are not recommended in the guidelines, the family aggregation in our series suggests it should be considered a close follow-up of the relatives of a patient with an NF1-related abdominal tumor. Also, for the first time, two mutations [c.2041C > T (p.Arg681Ter) and c.4537C > T (p.Arg1513*)] have been associated with family aggregation of abdominal tumors in NF1 patients.

Expert recommendations about the use of gadoxetic acid in patients with liver metastases in Spain.

BACKGROUND AND AIMS: Magnetic resonance imaging (MRI) with gadoxetic acid is widely used in clinical practice in Spain for the diagnosis, treatment, and follow-up of patients with liver metastases, although its use varies. This paper aims to provide recommendations for the use of MRI with gadoxetic acid in the detection and diagnosis of liver metastases in clinical practice in Spain. MATERIAL AND METHODS: This project was undertaken by a group of nine experts who analyzed a series of recommendations about the use of gadoxetic acid extracted from international consensus documents. From this analysis, the experts decided to reject, adopt, contextualize, or adapt each of the recommendations. Once established, the final recommendations were voted on by the same group of experts. RESULTS: The experts reached a consensus about five recommendations related to the use of this imaging technique in the management of liver metastases in three clinical situations: (i) in the detection, (ii) in the diagnosis and preoperative characterization, and (iii) in the detection after a chemotherapy treatment. CONCLUSION: The results support a clinical benefit for MRI with gadoxetic acid in the detection of liver metastases, favoring preoperative planning, especially in metastases measuring less than 1 cm, thus facilitating early diagnosis of metastatic spread.

PPARα polymorphisms association with total cholesterol and LDL-C levels in a Mexican population.

OBJECTIVE: Peroxisome proliferator-activated receptor alpha (PPARα) is a nuclear transcription factor with a role in gene expression changes associated to lipid metabolism. PPARα polymorphic variants have been previously correlated to serum lipid profile but in Mexico, there is no previous report about that association. For this reason, the aim of this study was to investigate the relationship between PPARα polymorphic variants and lipids level in serum in a Mexican population. PATIENTS AND METHODS: Two-hundred and forty women from the Northeast region of Mexico were included in the study. Anthropometric characteristics and serum lipid profile (such as triglycerides, total cholesterol, LDL cholesterol and HDL cholesterol) were evaluated. Genomic DNA extraction and purification were made from blood samples. Real-time PCR and TaqMan probes were used for genotyping of rs1800206 and rs4253778 single nucleotide polymorphisms (SNPs). RESULTS: Linear regression analysis (adjusted by age and body mass index (BMI)) showed a significant statistical association of rs4253778 with total cholesterol (p=0.034) and LDL cholesterol (p=0.037). Any significant association was found between rs1800206 and lipid levels. CONCLUSIONS: These results suggested that rs4253778 (C allele) is associated with high levels of total cholesterol and LDL in a Mexican women population.

Benefits of applying organic amendments from recycled wastes for fungal community growth in restored soils of a limestone quarry in a semiarid environment.

Applying organic amendments to recover physical, chemical, and biological qualities of soil may enable recovery of soils degraded by mining in semiarid climates. This study's aim was to investigate the development and changes in the composition of fungal communities in restored soils with five different types of organic amendments (two types of vegetable compost and sewage sludge compost, and a mixture of both) compared with unamended soils and surrounding natural soils and to examine the relationships between the fungal taxa, the new physico-chemical and biological soil properties of technosoils after 18 months of restoration, and natural soils. Restoration improved soil quality and fungal diversity, placing these soils in an intermediate position between unrestored soils (with no fungi present) and undisturbed reference soils, which were the most fungal diverse. Sewage-treated soils and their mixtures showed high nitrogen and carbohydrate content as well as high basal respiration and fatty acid content, suggesting that they provided readily biodegradable organic matter. In contrast, greenhouse compost-treated soils showed high total organic carbon and polyphenol content, whereas garden compost-treated soils showed intermediate values. The biological soil properties of both composts showed were similar to those of the reference soils, suggesting that composts contained more resilient organic matter. Organic amendments of dissimilar origin caused significantly different fungal soil communities at the genus level among the restored soils. Results indicated that soil pH, electrical conductivity, total nitrogen content, soil basal respiration, fungi/bacteria-PLFA ratio, and dehydrogenase and ß-glucosidase activities, together with Pearson's correlations, revealed that these properties and nutrient content (total organic carbon, C/N ratio, carbohydrates, and polyphenols) influenced 40 soil fungal taxa. Therefore, the organic amendments led to changes in soil properties that favoured plant cover by promoting the soil fungal community growth beneficial to the carbon cycle and symbiotic with plants.

Isotopic labelling-based analysis elucidates biosynthesis pathways in Saccharomyces cerevisiae for Melatonin, Serotonin and Hydroxytyrosol formation.

Yeasts can synthetise bioactive compounds such as Melatonin (MEL), Serotonin (SER) and Hydroxytyrosol (HT). Deciphering the mechanisms involved in their formation can lead to exploit this fact to increase the bioactive potential of fermented beverages. Quantitative analysis using labelled compounds, 15-N2 l-tryptophan and 13-C tyrosine, allowed tracking the formation of the above-mentioned bioactive compounds during the alcoholic fermentation of synthetic must by two different Saccharomyces cerevisiae strains. Labelled and unlabelled MEL, SER and HT were undoubtedly identified and quantified by High Resolution Mass Spectrometry (HRMS). Our results prove that there are at least two pathways involved in MEL biosynthesis by yeast. One starts with tryptophan as precursor being known for the vertebrates' pathway. Additionally, MEL is produced from SER which in turn is consistent with the plants' biosynthesis pathway. Concerning HT, it can be formed both from labelled tyrosine and from intermediates of the Erlich pathway.

Can we still consider treatment with colchicine effective in SARS-COV-2 infection? Systematic review, meta-analysis, and trial sequential analysis.

OBJECTIVE: To assess the effectiveness of colchicine, compared with standard of care, for reducing mortality, admission to intensive care, and use of mechanical ventilation. MATERIALS AND METHODS: We performed a systematic review, meta-analysis, and sequential trial analysis. The terms (SARS-CoV-2 OR COVID-19 OR coronavirus) AND (colchicine) were searched in MEDLINE, Scopus, Embase, Cochrane Central Register of Controlled Trials, and preprint repositories (February 2020 to April 2021, extended to June 2021). Risk of bias for randomised controlled trials and observational studies were assessed using the tools RoB 2.0 and ROBINS-I, respectively. We performed subgroup analyses based on study design and sensitivity analyses based on time of colchicine administration. RESULTS: We included six observational studies (1329 patients) and five clinical trials (16,048 patients). All studies but one were conducted in the hospital setting. Colchicine treatment was not associated with a significant decrease in mortality (RR 0.93, 95% CI 0.87 to 1; p=0.06, I2=72%) with a significant subgroup effect (p<0.001) depending on the design of the studies. The drug was effective in observational studies (RR 0.57, 95% CI 0.46 to 0.70, p<0.001, I2=50%) but not in clinical trials (RR 0.99, 95% CI 0.92 to 1.07, p=0.89, I2=21%). The effect of colchicine on intensive care admissions and the need for mechanical ventilation could not be confirmed. Trial sequential boundaries for cumulative meta-analyses of randomised controlled trials suggested no significant effect on mortality (p=0.182) beyond the optimal information size (13,107 patients). CONCLUSIONS: Our results suggest that colchicine treatment has no effect on mortality in hospitalised patients with SARS-CoV-2 infection, and that no further confirmatory clinical trials are needed owing to futility.

Soil amendments from recycled waste differently affect CO2 soil emissions in restored mining soils under semiarid conditions.

Drylands affected by serious disturbances such as mining activities lose their vegetation cover and organic soil horizons, becoming CO2 emissions sources. Applications of organic amendments could be a good restoration solution that favours vegetation establishment and soil carbon sequestration; however, they are also associated with CO2 emissions. Experimental plots with different organic amendments (sewage sludge, garden and greenhouse vegetable composts, and mixtures of both) and unamended soils were installed in a quarry in southeast Spain. The aim of this study was: i) to evaluate the magnitude and changes of in situ CO2 emission from each experimental plot during a year and a half, and ii) to assess the effects of several physical-chemical (total organic carbon, total nitrogen, water retention, pH and electrical conductivity) and environmental parameters (moisture and temperature) in CO2 emissions. The results showed an initial CO2 emission (priming effect), produced from all restored plots just after the application of the organic amendment, which was significantly higher (P < 0.05) in soils with sewage sludge and their mixtures in comparison to vegetable compost. Garden compost had low emission rates, similar to soils without amendment and showed lower CO2 emission rates than the rest of the restoration treatments. Nevertheless, CO2 emissions decreased in each field campaign over time, showing that all restored soils had lower emissions than natural soils at the end of the sampled period. The different composition of organic amendments had a different effect on soil CO2 emissions. DistLM analysis showed that soil properties such as total organic carbon, total nitrogen, pH and soil moisture, associated with rainfall periods, strongly influenced CO2 emissions, whereas temperature did not affect the CO2 flow. In conclusion, the compost from plant remains could serve better as treatment to restore degraded soils in drylands than sewage sludge because of its lower CO2 emissions and concomitant effect on climate warming and carbon balance.

Testing telediagnostic thyroid ultrasound in Peru: a new horizon in expanding access to imaging in rural and underserved areas.

PURPOSE: Thyroid ultrasound is a key tool in the evaluation of the thyroid, but billions of people around the world lack access to ultrasound imaging. In this study, we tested an asynchronous telediagnostic ultrasound system operated by individuals without prior ultrasound training which may be used to effectively evaluate the thyroid and improve access to imaging worldwide. METHODS: The telediagnostic system in this study utilizes volume sweep imaging (VSI), an imaging technique in which the operator scans the target region with simple sweeps of the ultrasound probe based on external body landmarks. Sweeps are recorded and saved as video clips for later interpretation by an expert. Two operators without prior ultrasound experience underwent 8 h of training on the thyroid VSI protocol and the operation of the telemedicine platform. After training, the operators scanned patients at a health center in Lima. Telediagnostic examinations were sent to the United States for remote interpretation. Standard of care thyroid ultrasound was performed by an experienced radiologist at the time of VSI examination to serve as a reference standard. RESULTS: Novice operators scanned 121 subjects with the thyroid VSI protocol. Of these exams, 88% were rated of excellent image quality showing complete or near complete thyroid visualization. There was 98.3% agreement on thyroid nodule presence between VSI teleultrasound and standard of care ultrasound (Cohen's kappa 0.91, P < 0.0001). VSI measured the thyroid size, on average, within 5 mm compared to standard of care. Readers of VSI were also able to effectively characterize thyroid nodules, and there was no significant difference in measurement of thyroid nodule size (P = 0.74) between VSI and standard of care. CONCLUSION: Thyroid VSI telediagnostic ultrasound demonstrated both excellent visualization of the thyroid gland and agreement with standard of care thyroid ultrasound for nodules and thyroid size evaluation. This system could be deployed for evaluation of palpable thyroid abnormalities, nodule follow-up, and epidemiological studies to promote global health and improve the availability of diagnostic imaging in underserved communities.

High-throughput sequencing-based analysis of bacterial communities associated with Barbour's seahorses (Hippocampus barbouri) from Surigao del Norte, Philippines.

This study identified the bacterial community composition associated with Barbour's seahorses (Hippocampus barbouri). Seahorses and samples from the surrounding environment (sediment and water) were collected from Cantiasay Island in Surigao del Norte, Philippines. Genomic DNA was isolated from these samples, and the V1-V3 region of the 16S rRNA gene was amplified and sequenced on the Illumina MiSeq platform. There were 929 803 sequence reads corresponding to 859 operational taxonomic units (OTUs), which were obtained from the six genomic libraries. The results showed that the most abundant OTUs were affiliated to the phylum Proteobacteria, particularly those belonging to the genera Shewanella, Pseudomonas, Acinetobacter and Aeromonas, which were found to be dominant in seahorse gut samples. The only exception was for the skin of male seahorses, which was dominated by members belonging to the genus Bacillus (phylum Firmicutes). These findings on bacterial community structure and composition may shed light on therapeutic claims of Barbour's seahorses and help in the conservation of this species.

Factores asociados al fracaso de la terapia con cánulas nasales de alto flujo en pacientes pediátricos con insuficiencia respiratoria en dos unidades de cuidados críticos pediátricos a gran altitud / Factors associated to high-flow nasal cannula treatment failure in pediatric patients with respiratory failure in two pediatric intensive care units at high altitude

Introducción: El fallo respiratorio agudo es la principal causa de hospitalización en pediatría. Las cánulas nasales de alto flujo (CNAF) ofrecen una nueva alternativa, pero sigue existiendo debate en torno a la evidencia e indicaciones. No se ha descrito su comportamiento en gran altitud. Objetivo Describir el uso de CNAF en pacientes pediátricos que ingresan con insuficiencia respiratoria y explorar los factores asociados al fracaso de la terapia. Metodología Estudio de cohortes prospectivo. Pacientes entre un mes y 18 años manejados con CNAF. Se describieron datos demográficos y se evaluó la respuesta al inicio, 1.a, 6.a y 24.a horas. Se determinó el número de fracasos, así como estancia, complicaciones y mortalidad. Se compararon los pacientes con fracaso al tratamiento. Resultados Ingresaron 539 pacientes. Fueron más frecuentes los lactantes (70,9%) de sexo masculino (58,4%) con afecciones respiratorias como asma y bronquiolitis (61,2%). Se presentaron 53 fracasos (9,8%), 21 en las primeras 24 horas. La mediana de estancia fue de 4 días (RIQ 4), hubo 5 éxitus (0,9%) y 13 eventos adversos –epistaxis– (2,2%). Se observó mejoría de signos vitales y gravedad en el tiempo con diferencias en el grupo que fracasó, pero sin interacciones. El modelo logístico final estimó una relación independiente del fracaso, entre el hospital (OR 2,78; IC95% 1,48-5,21) y la frecuencia respiratoria inicial (OR 1,56; IC95% 1,21-2,01). Conclusión La CNAF es un sistema con buena respuesta clínica, pocas complicaciones y una baja tasa de fracasos. Las diferencias entre las instituciones sugieren una relación subjetiva de la decisión del fracaso. (AU)

Introduction: Acute respiratory failure is the leading cause of hospitalization in pediatrics. High-flow nasal cannulas (HFNCs) offer a new alternative, but the evidence and indications are still debated. The performance of HFNCs at high altitude has not been described to date. Objective To describe the use of HFNCs in pediatric patients admitted with respiratory failure and explore the factors associated with treatment failure. Methodology A prospective cohort study was carried out in patients between 1 month and 18 years of age managed with HFNCs. The demographic and treatment response data were recorded at baseline and after 1, 6 and 24hours. The number of failures was determined, as well as the length of stay, complications and mortality. Patients with treatment failure were compared with the rest. Results A total of 539 patients were enrolled. Infants (70.9%) of male sex (58.4%) and airway diseases such as asthma and bronchiolitis (61.2%) were more frequent. There were 53 failures (9.8%), with 21 occurring in the first 24hours. The median length of stay was 4 days (IQR 4); there were 5 deaths (0.9%) and 13 adverse events (epistaxis) (2.2%). Improvement was observed in vital signs and severity over time, with differences in the group that failed, but without interactions. The final logistic model established an independent relationship of failure between the hospital (OR 2.78, 95%CI 1.48-5.21) and the initial respiratory rate (OR 1.56, 95%CI 1.21-2.01). Conclusions HFNCs afford good clinical response, with few complications and a low failure rate. The differences found between institutions suggest a subjective relationship in the decision of therapy failure. (AU)

Quarry restoration treatments from recycled waste modify the physicochemical soil properties, composition and activity of bacterial communities and priming effect in semi-arid areas.

The selection of a suitable organic amendment for recovery of semi-arid soils degraded by mining is key to the success of an ecological restoration. The aim of this research is to study the short-term responses of physicochemical, biochemical and biological properties, as well as the changes of a soil bacterial community at the genus level after application of five types of organic amendments in a limestone quarry in Almería (SE, Spain). The relationship among bacterial taxa with biochemical and physicochemical properties and priming effect from restored soils was also analysed. Six months after the application of organic amendments, the values of different soil status, such as total organic carbon, total nitrogen, assimilable phosphorus and labile organic matter forms (carbohydrates and polyphenols), basal respiration (BR) and enzymatic activities increased significantly with respect to unrestored soils. Similarly, a positive priming effect of soil organic matter mineralisation was produced by all organic amendments, being significantly higher (p < 0.05) in sewage sludge-treated soils. Bacterial diversity was higher in restored than in control soils. The restoration caused changes in soil bacterial communities' composition at the phylum and genus levels. It was observed that soil bacterial communities were significantly related to several physical, chemical and biochemical soil properties, establishing two different co-occurrence patterns between restored and unrestored soils. A first bacterial co-occurrence pattern showed significant positive correlations to pH and C/N ratio and negativity with the rest of the soil properties. The second bacterial pattern was positively correlated with carbohydrates, µg of C, priming effect, BR, ß-glucosidase and phosphatase and negatively with pH and C/N ratio. It was concluded that soil bacterial communities are clearly influenced by the types of organic amendments applied. Bacterial taxa such as Taibaiella or Pseudomonas could perform key functions in the carbon cycle in restored soils.

[Comparing group educational intervention to individual and self-learning in COPD]. / Comparación de intervención educacional grupal frente a una individual y el autoaprendizaje en EPOC.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is considered a public health issue which affects 10.2% of Spanish population between 40 and 80 years of age. Many patients do not perform well the inhalation technique. Error rates vary between 50-80% depending on the device under study. These values haven been proven to decrease with educational interventions. OBJECTIVE: To ascertain whether a group educational intervention is superior to an individual intervention or to a conventional approach in these patients as regards quality of life measured by means of the total score of the COPD Assessment Test (CAT),of adherence to treatment, exacerbations and hospitalizations. MATERIAL AND METHODS: A multicenter, multidisciplinary cluster-randomized controlled clinical trial with three branches (conventional intervention, individual intervention and group intervention) in a cohort of COPD-patients. Sociodemographic data and risk factors were collected and several questionnaires were completed (CAT, BODEx, Barthel, Lawton y Brody). A descriptive analysis of qualitative and quantitative variables and a multiple linear regression were conducted. OUTCOMES: 149 patients of average age 69.08 (SD 1.26). Significant differences were observed in CAT in the different intervention groups according to the level of severity on BODEx. The rate of patients performing well the inhalation technique was significantly lower at the beginning of the study and the number of exacerbations was lower after the intervention. Last year's exacerbations were linearly related to post-intervention suffering. CONCLUSIONS: Better results are obtained using the traditional and individual interventions. There is a decrease in number of exacerbations, hospitalizations, CAT score and post-intervention inhalation technique.