Parathyroidectomy: still the best choice for the management of severe secondary hyperparathyroidism / Paratireoidectomia: ainda a melhor escolha para o tratamento do hiperparatireoidismo secundário grave

Abstract Introduction: Management of secondary hyperparathyroidism (SHPT) is a challenging endeavor with several factors contruibuting to treatment failure. Calcimimetic therapy has revolutionized the management of SHPT, leading to changes in indications and appropriate timing of parathyroidectomy (PTX) around the world. Methods: We compared response rates to clinical vs. surgical approaches to SHPT in patients on maintenance dialysis (CKD 5D) and in kidney transplant patients (Ktx). A retrospective analysis of the one-year follow-up findings was carried out. CKD 5D patients were divided into 3 groups according to treatment strategy: parathyroidectomy, clinical management without cinacalcet (named standard - STD) and with cinacalcet (STD + CIN). Ktx patients were divided into 3 groups: PTX, CIN (cinacalcet use), and observation (OBS). Results: In CKD 5D we found a significant parathormone (PTH) decrease in all groups. Despite all groups had a higher PTH at baseline, we identified a more pronounced reduction in the PTX group. Regarding severe SHPT, the difference among groups was evidently wider: 31%, 14% and 80% of STD, STD + CIN, and PTX groups reached adequate PTH levels, respectively (p<0.0001). Concerning the Ktx population, although the difference was not so impressive, a higher rate of success in the PTX group was also observed. Conclusion: PTX still seems to be the best treatment choice for SHPT, especially in patients with prolonged diseases in unresourceful scenarios.

Resumo Introdução: O manejo do hiperparat-ireoidismo secundário (HPTS) é uma tarefa desafiadora com diversos fatores que contribuem para o fracasso do tratamento. A terapia calcimimética revolucionou o manejo do HPTS, levando a alterações nas indicações e no momento apropriado da paratireoidectomia (PTX) em todo o mundo. Métodos: Comparamos taxas de resposta às abordagens clínica vs. cirúrgica do HPTS em pacientes em diálise de manutenção (DRC 5D) e pacientes transplantados renais (TxR). Foi realizada uma análise retrospectiva dos achados de um ano de acompanhamento. Pacientes com DRC 5D foram divididos em 3 grupos de acordo com a estratégia de tratamento: paratireoidectomia, manejo clínico sem cinacalcete (denominado padrão - P) e com cinacalcete (P + CIN). Os pacientes com TxR foram divididos em 3 grupos: PTX, CIN (uso de cinacalcete) e observação (OBS). Resultados: Na DRC 5D, encontramos uma redução significativa do paratormônio (PTH) em todos os grupos. Apesar de todos os grupos apresentarem um PTH mais elevado no início do estudo, identificamos uma redução mais acentuada no grupo PTX. Com relação ao HPTS grave, a diferença entre os grupos foi evidentemente maior: 31%, 14% e 80% dos grupos P, P + CIN e PTX atingiram níveis adequados de PTH, respectivamente (p< 0,0001). Com relação à população TxR, embora a diferença não tenha sido tão impressionante, também foi observada uma taxa maior de sucesso no grupo PTX. Conclusão: A PTX ainda parece ser a melhor escolha de tratamento para o HPTS, especialmente em pacientes com doenças prolongadas em cenários sem recursos.

Lipolysis inhibition as a treatment of clinical ketosis in dairy cows: Effects on adipose tissue metabolic and immune responses.

Dairy cows with clinical ketosis (CK) exhibit excessive adipose tissue (AT) lipolysis and systemic inflammation. Lipolysis in cows can be induced by the canonical (hormonally induced) and inflammatory lipolytic pathways. Currently, the most common treatment for CK is oral propylene glycol (PG); however, PG does not reduce lipolysis or inflammation. Niacin (NIA) can reduce the activation of canonical lipolysis, whereas cyclooxygenase inhibitors such as flunixin meglumine (FM) can limit inflammation and inhibit the inflammatory lipolytic pathway. The objective of this study was to determine the effects of including NIA and FM in the standard PG treatment for postpartum CK on AT function. Multiparous Jersey cows [n = 18; 7.1 (SD = 3.8) DIM] were selected from a commercial dairy. Inclusion criteria were CK symptoms (lethargy, depressed appetite, and drop in milk yield) and high blood levels of ß-hydroxybutyrate (BHB ≥ 1.2 mmol/L). Cows with CK were randomly assigned to one of 3 treatments: 1) PG: 310 g administered orally once per d for 5 d, 2) PG+NIA: 24 g administered orally oral once per d for 3 d, 3) PG+NIA+FM: 1.1 mg/kg administered IV once per day for 3 d. Healthy cows (HC; n = 6) matched by lactation and DIM (±2 d) were sampled. Subcutaneous AT explants were collected at d 0 (d0) and 7 (d7) relative to enrollment. To assess AT insulin sensitivity, explants were treated with insulin (INS = 1 µL/L) during lipolysis stimulation with a ß-adrenergic receptor agonist (isoproterenol, ISO = 1 µM). Lipolysis was quantified by glycerol release in the media. Lipid mobilization and inflammatory gene networks were evaluated using real-time qPCR. Protein biomarkers of lipolysis, insulin signaling, and AT inflammation, including HSL, AKT, and ERK1/2, were quantified by capillary immunoassays. Flow cytometry of AT cellular components was used to characterize macrophage inflammatory phenotypes. Statistical significance was determined by a non-parametric t-test when 2 groups (HC vs CK) were analyzed and an ANOVA test with Tukey adjustment when 3 treatment groups (PG vs PGNIA vs PGNIAFM) were evaluated. At d0, AT from CK cows showed higher mRNA expression of lipolytic enzymes ABHD5, LIPE, and LPL, as well as increased phosphorylation of the lipase HSL (pHSL) compared with HC. At d0, INS reduced lipolysis by 41 ± 8% in AT from HC, while CK cows were unresponsive (-2.9 ± 4%). AT from CK cows exhibited reduced Akt phosphorylation compared with HC. CK had increased AT expression of inflammatory gene markers, including CCL2, IL8, IL10, TLR4, and TNF, along with ERK1/2 phosphorylation. AT from CK cows showed increased macrophage infiltration compared with HC. By d7, AT from PGNIAFM cows had a more robust response to INS, as evidenced by reduced glycerol release (36.5 ± 8% compared with PG, 26.9 ± 7%, and PGNIA, 7.4 ± 8%) and enhanced phosphorylation of Akt. By d7, PGNIAFM cows presented lower inflammatory markers, including ERK1/2 phosphorylation and reduced macrophage infiltration, compared with PG and PGNIA. These data suggest that including NIA and FM in CK treatment improves AT insulin sensitivity and reduces AT inflammation and macrophage infiltration.

Parathyroidectomy: still the best choice for the management of severe secondary hyperparathyroidism.

INTRODUCTION: Management of secondary hyperparathyroidism (SHPT) is a challenging endeavor with several factors contruibuting to treatment failure. Calcimimetic therapy has revolutionized the management of SHPT, leading to changes in indications and appropriate timing of parathyroidectomy (PTX) around the world. METHODS: We compared response rates to clinical vs. surgical approaches to SHPT in patients on maintenance dialysis (CKD 5D) and in kidney transplant patients (Ktx). A retrospective analysis of the one-year follow-up findings was carried out. CKD 5D patients were divided into 3 groups according to treatment strategy: parathyroidectomy, clinical management without cinacalcet (named standard - STD) and with cinacalcet (STD + CIN). Ktx patients were divided into 3 groups: PTX, CIN (cinacalcet use), and observation (OBS). RESULTS: In CKD 5D we found a significant parathormone (PTH) decrease in all groups. Despite all groups had a higher PTH at baseline, we identified a more pronounced reduction in the PTX group. Regarding severe SHPT, the difference among groups was evidently wider: 31%, 14% and 80% of STD, STD + CIN, and PTX groups reached adequate PTH levels, respectively (p<0.0001). Concerning the Ktx population, although the difference was not so impressive, a higher rate of success in the PTX group was also observed. CONCLUSION: PTX still seems to be the best treatment choice for SHPT, especially in patients with prolonged diseases in unresourceful scenarios.

Sustainability reporting in the construction industry - Status quo and directions of future research.

The construction industry's activities have significant effects on nature, society, and economic development. These effects and the accompanied societal expectations have encouraged companies to deal with and report on their contributions to sustainable development (SD). While the state of the literature on sustainability reporting (SR) has already been mapped for other sectors, this has not yet happened for the construction industry. Through a systematic literature review, we identified 67 articles that examine companies' motivations for SR, the design and content of the reports, as well as the use of the information in corporate sustainability management. Literature predominantly suggests that sustainability disclosure is driven mainly by instrumental or social/political motives, and that reports vary greatly in terms of content and quality. The variations can be attributed to different factors. However, utilizing reporting to its full potential requires linking it with corporate strategy and adapting management practices accordingly. Although the review provides comprehensive insights, it also indicates further research needs.

High-fat diet impairs glucose homeostasis by increased p16 beta-cell expression and alters glucose homeostasis of the progeny in a parental-sex dependent manner.

Introduction: Obesity consists in the accumulation of adipose tissue accompanied by low grade chronic inflammation and is considered a pandemic disease. Recent studies have observed that obesity affects females and males in a sex-dependent manner. In addition, several works have demonstrated that parental obesity increases the risk to develop obesity, insulin resistance, diabetes, and reproductive disorders. Considering that intergenerational effects of obesity may occur in a sex-dependent manner, we studied male Wistar rat progeny (F1) obtained from mothers or fathers (F0) fed on a high-fat diet (HFD). Methods: Five-week-old female and male Wistar rats were fed on a HFD (with 60% of calories provided by fat) for 18 weeks (F0). At the end of the treatment, animals were mated with young rats to obtain their progeny (F1). After weaning, F1 animals were fed on standard chow until 18 weeks of age. Body weight gain, fasting plasma glucose, insulin and leptin levels, glucose tolerance, insulin sensitivity, and adiposity were evaluated. In addition, beta-cell expression of nuclear p16 was assessed by immunofluorescence. Results and conclusions: HFD altered plasma fasting glucose, insulin and leptin levels, glucose tolerance, adiposity, and beta-cell expression of p16 in F0 rats. Particularly, HFD showed sexual dimorphic effects on body weight gain and insulin sensitivity. Moreover, we observed that parental HFD feeding exerts parental-sex-specific metabolic impairment in the male progeny. Finally, parental metabolic dysfunction could be in part attributed to the increased beta-cell expression of p16; other mechanisms could be involved in the offspring glucose homeostasis.

Advances in Material Modification with Smart Functional Polymers for Combating Biofilms in Biomedical Applications.

Biofilms as living microorganism communities are found anywhere, and for the healthcare sector, these constitute a threat and allied mechanism for health-associated or nosocomial infections. This review states the basis of biofilms and their formation. It focuses on their relevance for the biomedical sector, generalities, and the major advances in modified or new synthesized materials to prevent or control biofilm formation in biomedicine. Biofilm is conceptualized as an aggregate of cells highly communicated in an extracellular matrix, which the formation obeys to molecular and genetic basis. The biofilm offers protection to microorganisms from unfavorable environmental conditions. The most frequent genera of microorganisms forming biofilms and reported in infections are Staphylococcus spp., Escherichia spp., and Candida spp. in implants, heart valves, catheters, medical devices, and prostheses. During the last decade, biofilms have been most commonly related to health-associated infections and deaths in Europe, the United States, and Mexico. Smart, functional polymers are materials capable of responding to diverse stimuli. These represent a strategy to fight against biofilms through the modification or synthesis of new materials. Polypropylene and poly-N-isopropyl acrylamide were used enough in the literature analysis performed. Even smart polymers serve as delivery systems for other substances, such as antibiotics, for biofilm control.

Handgrip strength is associated with 12-month survival in male patients suffering with advanced chronic liver disease.

BACKGROUND: Advanced chronic liver disease (ACLD) patients are usually malnourished, and both conditions in combination increase the likelihood of unfavourable clinical outcomes. Handgrip strength (HGS) has been suggested as a relevant parameter for nutritional assessment and predictor of adverse clinical outcomes in ACLD. However, the HGS cut-off values for ACLD patients have not yet been reliably established. The aims of this study were to preliminarily identify HGS reference values in a sample population of ACLD male patients and to assess their association with survival over a 12-month follow-up period. METHODS: This was a prospective observational study with preliminary analysis of outpatients and inpatients. A total of 185 male patients with a medical diagnosis of ACLD met the inclusion criteria and were invited to participate in the study. The physiological variation in muscle strength related to the age of the individuals included in the study was considered to obtain cut-off values. RESULTS: After categorising HGS by age group (adults: 18-60 years; elderly: ≥60 years), the reference values obtained were 32.5 kg for the adults and 16.5 kg for the elderly. During the 12-month follow-up, 20.5% of the patients died, and 76.3% of those had been identified with reduced HGS. CONCLUSIONS: Patients with adequate HGS showed significantly higher 12-month survival than those with reduced HGS within the same period. Our findings show that HGS is an important predictive parameter for clinical and nutritional follow-up in ACLD male patients.

Respiratory and Photosynthetic Responses of Antarctic Vascular Plants Are Differentially Affected by CO2 Enrichment and Nocturnal Warming.

Projected rises in atmospheric CO2 concentration and minimum night-time temperatures may have important effects on plant carbon metabolism altering the carbon balance of the only two vascular plant species in the Antarctic Peninsula. We assessed the effect of nocturnal warming (8/5 °C vs. 8/8 °C day/night) and CO2 concentrations (400 ppm and 750 ppm) on gas exchange, non-structural carbohydrates, two respiratory-related enzymes, and mitochondrial size and number in two species of vascular plants. In Colobanthus quitensis, light-saturated photosynthesis measured at 400 ppm was reduced when plants were grown in the elevated CO2 or in the nocturnal warming treatments. Growth in elevated CO2 reduced stomatal conductance but nocturnal warming did not. The short-term sensitivity of respiration, relative protein abundance, and mitochondrial traits were not responsive to either treatment in this species. Moreover, some acclimation to nocturnal warming at ambient CO2 was observed. Altogether, these responses in C. quitensis led to an increase in the respiration-assimilation ratio in plants grown in elevated CO2. The response of Deschampsia antarctica to the experimental treatments was quite distinct. Photosynthesis was not affected by either treatment; however, respiration acclimated to temperature in the elevated CO2 treatment. The observed short-term changes in thermal sensitivity indicate type I acclimation of respiration. Growth in elevated CO2 and nocturnal warming resulted in a reduction in mitochondrial numbers and an increase in mitochondrial size in D. antarctica. Overall, our results suggest that with climate change D. antarctica could be more successful than C. quitensis, due to its ability to make metabolic adjustments to maintain its carbon balance.

Specific nutrition evaluation of patients with advanced chronic liver disease: Development and validation.

BACKGROUND: Malnutrition is frequently identified in patients with advanced chronic liver disease (ACLD), and its early identification is necessary for effective nutrition treatment. The aim of this study was to develop and validate a tool for specific nutrition evaluation of patients with ACLD (SNE-ACLD). METHODS: SNE-ACLD was developed by consensus among experts using Delphi technique. The initial proposal for the SNE-ACLD had six domains (history of weight loss, changes in food intake, gastrointestinal symptoms, changes in functional capacity, presence of complications of liver disease, and a nutrition-focused physical examination) and 11 items. Fifteen experts participated in content validation. In a cross-sectional study design, the new tool was applied to 129 inpatients and outpatients from a gastrohepatology unit. Nutrition status was evaluated with SNE-ACLD and subjective global assessment by one researcher. Content validation and semantic analysis were obtained by content validity index. To verify accuracy of SNE-ACLD, the sensitivity, specificity, Youden index, and area under the receiver operating characteristic curve (AUC) were calculated. RESULTS: After five evaluative sequences conducted by experts, experts excluded the domain for history of weight loss and its respective item. The final version of SNE-ACLD consists of five domains and 10 items. The new instrument showed good accuracy in identifying any level of malnutrition (AUC = 0.83; 95% CI, 0.76-0.91) and severe malnutrition (AUC = 0.90; 95% CI, 0.79-1.00). CONCLUSION: SNE-ACLD can be used in nutrition assessment of patients with liver disease. Future works should investigate its agreement with other methods and its predictive value.

Returning to PD after kidney transplant failure is a valuable option.

PURPOSE: There is a paucity of data on the prognosis for patients returning to peritoneal dialysis (PD) after a failed transplant. PD has an advantage over hemodialysis in preserving residual renal function, which is associated with better outcomes. METHODS: We have reviewed the electronic charts of patients on PD in a tertiary academic hospital for the last 8 years. We have compared technique survival, peritonitis-free survival, and residual diuresis in two groups: patients with graft failure which returned to PD (PD-KTx, N = 18) and patients starting PD for other causes (PD-not KTx, N = 163). RESULTS: The median follow-up was similar between groups [42(16,71) in PD-not KTx vs. 48(22,90) months in PD-KTx, p = 0.293]. Kaplan-Meier survival comparing PD-KTx and PD-not KTx showed no difference in technique survival (p = 0.196), and peritonitis-free survival (log-rank 0.238), which were confirmed in a fully adjusted Cox regression. Diuresis at baseline and at the end of the first year was similar between groups (p = 0.799 and p = 0.354, respectively). Six out of 18 patients from the PD-KTx group had the immunosuppression maintained and none of those had peritonitis. The reduction of diuresis across the first year of PD was significant for all patients, except for those on continued immunosuppressive therapy. CONCLUSION: PD is a worthy dialysis alternative after a failed kidney transplant, providing similar outcomes when compared to patients who started PD for other reasons.

Unusual presentation of Ramsay-Hunt Syndrome in kidney transplant patient.

Herpes Zoster (HZ) is caused by reactivation of latent varicella zoster virus (VZV) in craniospinal sensory neurons and is characterized by a painful erythematous rash in the affected dermatome. Although kidney transplant recipients who are chronically maintained on immunosuppressive regimens are considered at risk, there are only a few cases described. We report a well-documented case of a 50-year-old male kidney transplant recipient who presented Ramsay-Hunt syndrome with atypical neurological finds.

Cov-hep study: heparin in standard anticoagulation based on citrate for continuous veno-venous hemodialysis in patients with COVID-19: a structured summary of a study protocol for a randomized controlled trial.

OBJECTIVES: The primary objective is to test if heparin added to a standard regional anticoagulation protocol based on citrate is able to reduce dialysis circuit losses by clotting without increasing the risk of thrombocytopenia or bleeding, in patients with COVID-19 with acute kidney injury requiring dialysis. TRIAL DESIGN: Randomized, parallel-group, open-label trial, with two arms (ratio 1:1) comparing different continuous renal replacement therapy anticoagulation strategies. PARTICIPANTS: Eligibility conditions: All ICU patients of University of Sao Paulo General Hospital (Hospital das Clínicas), Brazil will be screened for eligibility conditions. Adults (> 18 years old) with confirmed COVID-19 and acute kidney injury requiring dialysis with agreement between ICU and nephrology teams for the introduction of renal continuous replacement therapy in daily ICU rounds. Continuous renal replacement therapy will be prescribed by consulting nephrologists based on standard clinical guidelines, including acute kidney injury with hemodynamic instability plus hyperkalemia, severe acidosis, volume overload, respiratory distress, multiorgan failure or some combination of these factors. DATA COLLECTION: Patients demographics and associated clinical data and comorbidities will be recorded at ICU entry. Demographic information will include the patient's age, sex, and admission dates. Clinical data comprise comorbidities, APACHE 2, SAPS 3, need for mechanical ventilation, and use of vasopressor drugs. Physiological data collected by the day of CRRT start will be vital signs, the arterial oxygen tension/fraction of inspired oxygen (PaO2/FiO2) index, and serum creatinine, blood urea nitrogen, bilirubin, hemoglobin, hematocrit, platelets, white blood cell count levels and Peak D-dimer levels. Patients will be analyzed for the first 72h of CRRT, and they will be evaluated regarding clinical variables, filter patency and any adverse events that could be related to the anticoagulation choice, as bleeding (mild or major) or low platelets counts (<100.000 ui/uL) during treatment period. Mild and major bleeding will be defined by hemorrhagic event without clinical impact or hemoglobin (Hb) fall lesser than 1g/dL and hemorrhagic event with clinical impact or Hb fall higher than 1g/dL, respectively. EXCLUSION CRITERIA: Hypersensitivity to any of the substances going to be used in the study (Citric acid dextrosol 2.2% and unfractionated heparin); Previous diagnosis of coagulopathy or thrombophilia; Contraindication to the use of unfractionated heparin; Risk of citrate poisoning - (Lactate> 30 mg/dL, international normalized ratio > 2.5, Total bilirubin> 15 mg/dL); Pregnancy; Patients unlikely to survive for more than 24 hours. The trial is being undertaken at the University of Sao Paulo General Hospital (Hospital das Clinicas), Brazil. INTERVENTION AND COMPARATOR: Group A (control) - Patients on continuous renal replacement therapy (blood flow 150 ml/min, dose of 30 mL/Kg/h) receiving anticoagulation with sodium citrate at 4 mmol/L Group B (experiment): Patients on continuous hemodialysis (blood flow 150 mL/min, dose of 30 mL/Kg/h) receiving anticoagulation with sodium citrate at 4 mmol/L associated with unfractionated heparin at 10 U/Kg/h. MAIN OUTCOMES: The percentage of clotted dialyzers within 72 hours in each of the studied groups (Primary outcome) Secondary outcomes: Number of dialyzers used in the first 72 hours of dialysis protocol, Mortality in the first 72 h of dialysis protocol, Bleeding events (Major or minor) in the first 72 h of dialysis protocol, Thrombocytopenia (less than 50.000 platelets) proportion in the first 72 h of dialysis protocol, Dialysis efficiency (Urea sieving) - variation in urea sieving between the first, second and third days of dialysis protocol, Continuous renal replacement therapy pressures (Arterial, Venous, dialysate and pre-filter pressure) in the first 72 h of dialysis protocol, in-hospital mortality. RANDOMIZATION: RedCap→ randomization - 2 blocks randomization by D-dimer level (5000ng/dL cut-off) and catheter site (Right Internal Jugular versus other sites) with 1:1 allocation ratio. BLINDING (MASKING): No blinding - Open label format NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): Total number of patients 90 (45 per group) TRIAL STATUS: Trial version 2.0 - ongoing recruitment. First recruitment: June 29, 2020 Estimated date for last recruitment: December 31, 2020 TRIAL REGISTRATION: Responsible Party: University of Sao Paulo General Hospital (Hospital das Clinicas) ClinicalTrials.gov Identifier: NCT04487990 , registered July 27, 2020, ReBec www.ensaiosclinicos.gov.br/rg/RBR-45kf9p/ Other Study ID Numbers: U1111-1252-0194 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1) In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

Cell Culture Platforms with Controllable Stiffness for Chick Embryonic Cardiomyocytes.

For several years, cell culture techniques have been physiologically relevant to understand living organisms both structurally and functionally, aiming at preserving as carefully as possible the in vivo integrity and function of the cells. However, when studying cardiac cells, glass or plastic Petri dishes and culture-coated plates lack important cues that do not allow to maintain the desired phenotype, especially for primary cell culture. In this work, we show that microscaffolds made with polydimethylsiloxane (PDMS) enable modulating the stiffness of the surface of the culture substrate and this originates different patterns of adhesion, self-organization, and synchronized or propagated activity in the culture of chick embryonic cardiomyocytes. Thanks to the calcium imaging technique, we found that the substrate stiffness affected cardiomyocyte adhesion, as well as the calcium signal propagation in the formed tissue. The patterns of activity shown by the calcium fluorescence variations are reliable clues of the functional organization achieved by the cell layers. We found that PDMS substrates with a stiffness of 25 kPa did not allow the formation of cell layers and therefore the optimal propagation of the intracellular calcium signals, while softer PDMS substrates with Young's modulus within the physiological in vivo reported range did permit synchronized and coordinated contractility and intracellular calcium activity. This type of methodology allows us to study phenomena such as arrhythmias. For example, the occurrence of synchronized activity or rotors that can initiate or maintain cardiac arrhythmias can be reproduced on different substrates for study, so that replacement tissues or patches can be better designed.

Contrasting thermal acclimation of leaf dark respiration and photosynthesis of Antarctic vascular plant species exposed to nocturnal warming.

Leaf respiration and photosynthesis will respond differently to an increase in temperature during night, which can be more relevant in sensitive ecosystems such as Antarctica. We postulate that the plant species able to colonize the Antarctic Peninsula - Colobanthus quitensis (Kunth) Bartl. and Deschampsia antarctica Desv. - are able to acclimate their foliar respiration and to maintain photosynthesis under nocturnal warming to sustain a positive foliar carbon balance. We conducted a laboratory experiment to evaluate the effect of time of day (day and night) and nocturnal warming on dark respiration. Short (E0 and Q10 ) and long-term acclimation of respiration, leaf carbohydrates, photosynthesis (Asat ) and foliar carbon balance (R/A) were evaluated. The results suggest that the two species have differential thermal acclimation respiration, where D. antarctica showed more thermosensitivity to short-term changes in temperature than C. quitensis. Experimental nocturnal warming affected respiration at daytime differentially between the two species, with a significant increase of R10 and Asat in D. antarctica, while no changes on respiration were observed in C. quitensis. Long thermal treatments of the plants indicated that nocturnal but not diurnal respiration could acclimate in both species, and to a greater extent in C. quitensis. Non-structural carbohydrates were related with respiration in C. quitensis but not in D. antarctica, suggesting that respiration in the former species is likely controlled by total soluble sugars and starch during day and night, respectively. Finally, foliar carbon balance was differentially improved under warming conditions in Antarctic plants by different mechanisms, with C. quitensis deploying respiratory acclimation, while D. antarctica increased its Asat.

What do Chilean and Costa Rican psychologists believe and advise about parenting? / ¿Qué creen y aconsejan psicólogos (as) chilenos (as) y costarricenses sobre la crianza de los (as) hijos (as)?

Abstract This research investigates the subjective theories of 12 Chilean and Costa Rican psychologists who work with children, with the purpose of describing and interpreting their explanations about child rearing. Episodic interviews were used and analyzed using a Grounded Theory model. The interviewees point out that they use their own experience and beliefs when advising parents. Results indicated that, according to the interviewees, the topics most frequently consulted by parents were children's high impulsivity and disciplining. The interviewees believe the most common parenting styles are the authoritarian and the permissive ones, the latter being associated with parents' fear and anxiety.

Resumen Este estudio investigó las teorías subjetivas de 12 psicólogos(as) chilenos(as) y costarricenses que trabajan en temáticas de infancia, a objeto de poder describir e interpretar sus explicaciones sobre la crianza. Esta investigación fue de carácter cualitativo, con un diseño metodológico descriptivo-interpretativo. Se realizaron entrevistas episódicas, analizadas utilizando el modelo de la Grounded Theory (teoría fundamentada). Los participantes señalaron usar sus propias experiencias y creencias al aconsejar a los padres y a las madres. Según los (as) entrevistados (as), los padres y las madres consultan principalmente sobre la impulsividad y disciplina de los (as) hijos (as). De acuerdo a los (as) entrevistados (as), los estilos parentales más recurrentes son el autoritario y el permisivo, este último asociado con el miedo y ansiedad de los padres y madres.