Microphytobenthos spatio-temporal dynamics across an intertidal gradient using Random Forest classification and Sentinel-2 imagery.

Microphytobenthos (MPB) provides important ecosystem functions and services, contributing significantly to the total primary production in shallow coastal ecosystems. However, determining the factors that regulate the seasonal changes of MPB and its distribution patterns at larger scales is hindered by the considerable spatial and temporal variability in these environments. Here, we studied the dynamics of intertidal MPB biomass, cover, and net growth rates in a south European tidal flat (Cadiz Bay, Spain) over a four-year period using the Normalized Difference Vegetation Index (NDVI) calculated from Sentinel-2 satellite images. Pixels dominated by different benthic communities (MPB, Zostera sp., Caulerpa sp. and green macroalgae) were identified at a 10-m resolution using a Random Forest (RF) machine learning classification algorithm. MPB dominated the intertidal zone. MPB cover did not show a clear seasonal pattern and was clearly higher in the middle of the intertidal range of sea level. Despite interannual variability, MPB biomass was always higher during winter, coinciding with observations from other low latitude intertidal flats with temperate climate, and in the upper-middle intertidal. Net rates of MPB biomass change, calculated from the differences in MPB NDVI over time, showed maximal net growth rates from autumn to winter and maximum loss rates during spring and summer, although with high variability. Our study demonstrates that RF algorithms allow mapping MPB and other intertidal communities from Sentinel-2 multispectral satellite imagery accurately obtaining invaluable information from large areas at very high spatio-temporal resolution. The dissimilarities observed in the patterns of MPB variables over time or sea level, indicate differences in their ecological regulation, still largely unknown both here and in other temperate climate intertidal flats. High resolution remote sensing can aid in their detailed and systematic study producing a more integrated view of these systems and contributing to their science-based management and conservation.

Diel patterns of microphytobenthic primary production in intertidal sediments: the role of photoperiod on the vertical migration circadian rhythm.

Diel primary production patterns of intertidal microphytobenthos (MPB) have been attributed to short-term physiological changes in the photosynthetic apparatus or to diel changes in the photoautotrophic biomass in the sediment photic layer due to vertical migration. Diel changes in primary production and vertical migration are entrained by external factors like photoperiod and tides. However, the role of photoperiod and tides has not been experimentally separated to date. Here, we performed laboratory experiments with sediment cores kept in immersion, in the absence of tides, with photoperiod or under continuous light. Measurements of net production, made with O2 microsensors, and of spectral reflectance at the sediment surface showed that, in intertidal sediments, the photoperiod signal was the major driver of the diel patterns of net primary production and sediment oxygen availability through the vertical migration of the MPB photoautotrophic biomass. Vertical migration was controlled by an endogenous circadian rhythm entrained by photoperiod in the absence of tides. The pattern progressively disappeared after 3 days in continuous light but was immediately reset by photoperiod. Even though a potential contribution of a subjective in situ tidal signal cannot be completely discarded, Fourier and cross spectral analysis of temporal patterns indicated that the photosynthetic circadian rhythm was mainly characterized by light/dark migratory cycles.

Alicycliphilus: current knowledge and potential for bioremediation of xenobiotics.

Alicycliphilus is a promising candidate for participating in the development of novel xenobiotics bioremediation processes. Members of the Alicycliphilus genus are environmental bacteria mostly found in polluted sites such as landfills and contaminated watercourses, and in sewage sludges from wastewater treatment plants. They exhibit a versatile metabolism and the ability to use oxygen, nitrate and chlorate as terminal electron acceptors, which allow them to biodegrade xenobiotics under oxic or anoxic conditions. Pure cultures of Alicycliphilus strains are able to biodegrade some pollutants such as industrial solvents (acetone, cyclohexanol and N-methylpyrrolidone), aromatic hydrocarbons (benzene, toluene and anthracene), as well as polyurethane varnishes and foams, and they can even transform Cr(VI) to Cr(III). In addition, Alicycliphilus has also been identified in bacterial communities involved in wastewater treatment plants for denitrification, and the degradation of emerging pollutants such as triclosan, nonylphenol, N-heterocyclic aromatic compounds (indole and quinoline), and antibiotics (tetracycline and oxytetracycline). This work summarizes the current knowledge on the Alicycliphilus genus, describing its different metabolic characteristics, focusing on its xenobiotic biodegradation abilities and examining the distinct pathways and molecular bases that sustain them. We also discuss the progress made in genetic manipulation and 'omics' analyses, as well as Alicycliphilus participation in novel bioremediation strategies.

Interventional Cultural and Language Assistance Program: Associations between Cultural and Linguistic Factors and Satisfaction with Cancer Care.

Addressing language and cultural nuance is required to improve the quality of care among all patients. The tenth version of the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS) recommends implementing ongoing assessments to integrate specific actions into measurement and continuous quality improvement activities. To this end, we have created the Interventional Cultural and Language Assistance Program (ICLAP). As part of ICLAP, we conducted a cross-sectional needs assessment survey with 564 consecutive patients receiving outpatient Positron emission tomography-computed tomography (PET/CT) imaging at a comprehensive cancer center in the five most prevalent languages of New York City: English, Spanish, Russian, Chinese, and Arabic. The purpose of this study is to describe the language assistance characteristics and needs of a sample of patients receiving care in the cancer center. We examined the relationship between race, ethnicity, birthplace, communication and language assistance characteristics and the satisfaction with the care received. Our results show that race and ethnicity, birthplace, cultural beliefs, language assistance, and communication characteristics were all factors associated with patients' satisfaction with care, illustrating that there is an unmet need among cancer patients to have cultural and linguistic sensitive services.

Routine invasive strategy in acute coronary syndrome patients with renal dysfunction. Results of the ARIAM-SEMICYUC registry. / Estrategia invasiva de rutina en el síndrome coronario agudo sin elevación del segmento ST con disfunción renal. Resultados del registro ARIAM-SEMICYUC.

OBJECTIVE: To evaluate the use and effectiveness of a routine invasive strategy (RIS) in patients with acute coronary syndrome without persistent ST-segment elevation with renal dysfunction in the real world scenario. METHODS: A retrospective cohort study based on the ARIAM-SEMICYUC Registry (2011-2014) was carried out. Renal dysfunction was defined as GFR (Cockroft-Gault)<60ml/min (moderate dysfunction) or<30ml/min (severe dysfunction). Patients in which early angiography (<72h) was performed due to cardiogenic shock or recurrent myocardial ischemia were excluded. The primary endpoint was hospital mortality. Confounding factors were controlled using propensity score analysis. RESULTS: A total of 4,279 patients were analyzed, of which 26% had moderate renal dysfunction and 5% severe dysfunction. Patients with renal dysfunction had greater severity and comorbidity, higher hospital mortality (8.6 vs. 1.8%), and lesser use of the RIS (40 vs. 52%). The adjusted OR for mortality in patients without/with renal dysfunction were 0.38 (95% confidence interval [95%CI] 0.17 to 0.81) and 0.52 (95%CI 0.32 to 0.87), respectively (interaction P-value=.4779). The impact (adjusted risk difference) of RIS was higher in the group with renal dysfunction (-5.1%, 95%CI -8.1 to -2.1 vs. -1.6%, 95%CI -2.6 to -0.6; interaction P-value=.0335). No significant interaction was detected for the other endpoints considered (ICU mortality, 30-day mortality, myocardial infarction, acute renal failure or moderate/severe bleeding). CONCLUSIONS: The results suggest that the effectiveness of IRS is similar in patients with normal or abnormal renal function, and alert to the under-utilization of this strategy in such patients.

[Accessibility to health care of diabetic patients with acute coronary syndrome ST-segment elevation]. / Accesibilidad al sistema sanitario de los pacientes diabéticos con síndrome coronario agudo con elevación del segmento ST.

OBJECTIVES: To measure accessibility to health care among diabetic patients and analyze whether differences in delay explain differences in hospital mortality. METHODS: A retrospective cohort study was conducted in diabetic patients with acute coronary syndrome with ST-segment elevation included in the ARIAM-SEMICYUC registry (2010-2013). Crude and adjusted analyses were performed using unconditional logistic regression. RESULTS: A total of 4817 patients were analyzed, of whom 1070 (22.2%) were diabetics. No differences were found in access to health care between diabetic and non-diabetic patients. Diabetic patients presented with longer patient delay (90 min vs. 75 min; p=.004) and prehospital delay (150 min vs. 130 min; p=.002). Once the health system was contacted, diabetic patients had a lower reperfusion rate (50% vs. 57.7%; p<.001), but no longer delay in treatment was observed compared with the non-diabetic individuals. Diabetic patients have greater in-hospital mortality (12.5 vs. 6%; p <.001), though neither patient delay nor prehospital delay were identified as independent predictors of in-hospital mortality. CONCLUSIONS: Diabetic patients had a longer delay in access to health care, though such delay was not independently related to increased mortality.

Characterization of Elastofibroma Dorsi with (18)FDG PET/CT: a retrospective study.

UNLABELLED: Elastofibroma dorsi has been described in the literature as an unusual tumor or pseudotumor. However, autopsies and imaging studies have revealed that it is a non-negligible finding. PURPOSE: The aim of this study has been to illustrate and become familiar with this type of lesion in order to prevent misdiagnosis. MATERIALS AND METHODS: From 3 December 2008 to 5 January 2010, 1,751 patients were evaluated with (18)FDG-PET/CT. Of these, 29 cases of elastofibroma dorsi were recorded as an incidental finding. A retrospective and descriptive analysis was performed on this study series. RESULTS: The study showed a prevalence of 1.66%. Out of the 29 findings, 22 (75.86%) were females and 7 (24.14%) males. Seventeen (58.62%) cases were bilateral, 12 (41.38%) unilateral and the SUVmax ranged from 1.4 to 3.2. These lesions were reported as soft tissue density images with mild or moderate diffuse metabolic activity. CONCLUSION: The elastofibroma dorsi is a relatively common finding in PET/CT that should be known in order to avoid making wrong diagnoses.

Réplica a la carta al director "prevención de hematomas de pared abdominal cuando se emplean heparinas de bajo peso molecular" / Prevention of abdominal wall hematomas in patients receiving low molecular weight heparin therapy

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Hematoma masivo de pared abdominal y hemoperitoneo secundario a la administración subcutánea de heparina de bajo peso molecular / Massive abdominal wall hematoma and hemperitoneum secondary to subcutaneous infusion of low molecular weight heparin

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Intimidad, confidencialidad e historia clínica informatizada: reflexiones tras el caso del Dr. Ángel RuizTéllez / Intimacy, confidentiality and comuterised clinical records: reflections following the case of Dr. Ángel Ruiz Téllez

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Tratamiento del dolor en cirugía mayor ambulatoria / No disponible

El objetivo de esta revisión es evaluar el estado actual y las perspectivas futuras del tratamiento del dolor agudo postoperatorio en Cirugía Mayor Ambulatoria(CMA). Basándonos en los estudios y revisiones publicadas podemos concluir: 1. El dolor postoperatorio es la causa médica más frecuente de demoras en el alta en una unidad de CMA, y uno de los principales motivo de ingreso hospitalario. 2. Un porcentaje importante de pacientes dados de alta, pueden tener dolor de moderado a severo durante las primeras 24-48 horas del periodo postoperatorio, aunque durante los últimos años disminuyo gracias a los esfuerzos realizados por el personal médico y de enfermería. 3. Es importante informar al paciente del grado de dolor esperado y de las alternativas de que disponemos para tratarlo. 4. No existen pautas de tratamiento universales debido a la gran variabilidad de procedimientos realizados en CMA, por lo que los protocolos anestésico- analgésicos deben individualizarse según la intensidad del trauma quirúrgico. 5. Una buena analgesia postoperatoria es una de las claves del éxito de los programas de CMA y se ha demostrado que el grado de satisfación del paciente guarda una relación directa con el control del dolor postoperatorio. 6. El paracetamoly los AINES son los fármacos mas empleados para el tratamiento del dolor postoperatorio, aunque durante los últimos años debido a la incorporación de procedimientos más complejos y dolorosos existen múltiples evidencias de que estos fármacos solos producen analgesia inadecuada. 7. La realización de técnicas anestésicas-analgésicas multimodales son las que proporcionan mayor eficacia analgésica en el postoperatorio.8. En la actualidad disponemos de técnicas y métodos eficientes y seguros para garantizar la consecución de analgesia postoperatoria (analgesia continua mediante sistemas de infusión elastoméricos) tras procedimientos que producen dolor intenso (AU)

The object of this review was to evaluate the present state and future perspectives of the treatment of postoperative pain in Ambulatory Surgery. Based on published revisions and studies we concluded that: 1. Postoperative pain is the most common medical cause which delays discharge from the Ambulatory Unit and is one of the main reasons for hospital admission. 2. An important percentage of discharged patients will experiment moderate to severe pain during the first 24-48hours following surgery, although this percentage has decreased in the last few years thanks to the efforts of medical and nursing personnel. 3. It is important to inform the patients of the amount of pain they can expect and of the possible means of treating it. 4. There are no universal methods for pain management due to the large number of different procedures undertaken in Ambulatory Surgery, therefore anaesthetic-analgesic protocols should be individualized depending on surgical trauma. 5. Good postoperative analgesia is essential in Ambulatory Surgical Programmes. The degree of patient satisfaction has been shown to be directly related to the control of postoperative pain. 6. Paracetamol and NSAID are the drugs most frequently used to control postoperative pain, although, over the last few years, and due to the increase of more complex and painful procedures, it is evident that these drugs only produce inadequate analgesia. 7. Multiple (..) (AU)

Obstrucción de vía aérea superior por angioedema en paciente con infarto de miocardio sometido a tratamiento fibrinolítico con activador tisular del plasminógeno / Upper airway obstruction by angioedema following thrombolytic therapy with recombinant tissue plasminogen activator in patient with acute myocardial infarction

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Mesophilic aeromonads in wild and aquacultured freshwater fish.

Numbers and species of motile Aeromonas were determined in freshly caught freshwater fish, in the surrounding environment, and also during iced chilled storage of fish specimens. Although no significant differences were observed in water samples, initial levels for skin, gill, and intestines were significantly lower in farmed rainbow trout (Oncorhynchus mykiss) than in wild brown trout (Salmo trutta) and pike (Esox lucius). During storage of wild specimens, naturally occurring aeromonads grew fairly well on the surfaces of skin and body cavity. Of 171 strains assigned to the genus Aeromonas, 88% were identified to phenospecies and putative genospecies level by using comprehensive biochemical schemes. The isolates were allocated to putative hybridization groups (HGs) 1 and 3 Aeromonas hydrophila (29%); putative HG 8 Aeromonas veronii biovar sobria (19%); putative HG 2 Aeromonas bestiarum (18%); putative HG 9 Aeromonas jandaei (16%); putative HGs 4 and 5a Aeromonas caviae (2%); putative HG 12 Aeromonas schubertii (2%); and putative HG 11 (unnamed, 0.6%). The remaining 20 isolates (12%) resembled A. schubertii but could not be allocated to currently recognized phenospecies or to putative HGs. Although cultured rainbow trout yielded strains of putative HGs 1, 4, and 8, which appear to be of major clinical importance, most isolates assigned to putative HGs 1 and 8 were recovered from pike. Differences among HGs found in wild animals could be related to their origin (unpolluted rivers for brown trout and urban rivers for pike). The recovery of these aeromonads species was not related to sampling site. The initial levels of motile aeromonads, their behavior during storage, and the strong potential spoilage activity of most isolates confirm that these bacteria can contribute to deterioration of iced wild freshwater fish. Although adequate cooking would inactivate motile aeromonads, the high incidence of isolates belonging to gastroenteritis-associated HGs should be regarded as a potential health concern, particularly for susceptible populations when there is a possibility of cross-contamination.

Psychrobacters and related bacteria in freshwater fish.

Three phenotypic identification systems were employed to identify 106 strains of gram-negative, nonmotile, aerobic bacteria obtained during iced storage of wild (Salmo trutta and Esox lucius) and farmed (Oncorhynchus mykiss) freshwater fish. Using diagnostic tables and computer-assisted identification, the isolates were Psychrobacter (64 strains), Acinetobacter (24 strains), Moraxella (6 strains), Chryseobacterium (5 strains), Myroides odoratus (2 strains), Flavobacterium (1 strain), Empedobacter (1 strain), and unidentified (3 strains). Overall similarities of all strains were determined for 108 characters by numerical analysis (simple matching coefficient of similarity [S] and clustering by unweighted pair group average linkage [UPGMA]). At the 77% similarity level, 92 strains formed nine major clusters (3 or more strains) and four small clusters (2 strains). Cluster 1 (25 isolates divided into two main subclusters) could be assigned to Psychrobacter phenylpyruvicus, clusters 2 and 3 (26 isolates) were designated as Psychrobacter immobilis, and clusters 4 (3 isolates) and 7 (4 isolates) were identified as Psychrobacter urativorans and Psychrobacter spp., respectively. Clusters 5 (five isolates), 6 (three isolates), and 9 (five isolates) were labeled as Acinetobacter spp., Acinetobacter johnsonii, and Acinetobacter lwoffii, respectively. Cluster 8 (12 isolates), with a high resemblance to Thornley's phenon 4 (a heterogeneous group of bacteria isolated from poultry and related to Acinetobacter), remained unnamed. The restriction pattern was identical for strains grouped into clusters 2 and 3 (P. immobilis) but was different for the remaining Psychrobacter isolates. A large proportion of isolates belonging to the family Moraxellaceae were closely related. Psychrobacters and A. johnsonii were present in freshly caught fish and river water. In the latter stages of storage, P. phenylpyruvicus and acinetobacters tended to decrease, whereas P. immobilis increased.

Hemolytic and elastolytic activities influenced by iron in Plesiomonas shigelloides.

The aim of this study was to determine the presence of hemolytic and elastolytic enzymes in several strains of Plesiomonas shigelloides in relation to the availability of iron in culture media. Hemolytic activity and elastolytic activity were detected in strains of P. shigelloides and were enhanced when the strains were grown in an iron-depleted medium and lost after thermal treatment at 100 degrees C for 10 min. Also, elastolytic activity was inactivated by phenylmethyl sulfonyl fluoride, an inhibitor of serine proteases. Hemolytic activity was detected extracellularly in cell-free supernatants, whereas elastin degradation activity was cell associated. Both activities may be related to the virulence of P. shigelloides.