Restricted dispersal in a sea of gene flow.

How far do marine larvae disperse in the ocean? Decades of population genetic studies have revealed generally low levels of genetic structure at large spatial scales (hundreds of kilometres). Yet this result, typically based on discrete sampling designs, does not necessarily imply extensive dispersal. Here, we adopt a continuous sampling strategy along 950 km of coast in the northwestern Mediterranean Sea to address this question in four species. In line with expectations, we observe weak genetic structure at a large spatial scale. Nevertheless, our continuous sampling strategy uncovers a pattern of isolation by distance at small spatial scales (few tens of kilometres) in two species. Individual-based simulations indicate that this signal is an expected signature of restricted dispersal. At the other extreme of the connectivity spectrum, two pairs of individuals that are closely related genetically were found more than 290 km apart, indicating long-distance dispersal. Such a combination of restricted dispersal with rare long-distance dispersal events is supported by a high-resolution biophysical model of larval dispersal in the study area, and we posit that it may be common in marine species. Our results bridge population genetic studies with direct dispersal studies and have implications for the design of marine reserve networks.

Clostridioides difficile infection in a long-term convalescence hospital: A real tale of pitfalls and outdated therapy.

OBJECTIVE: The aim of the study was to know the characteristics and risk factors of Clostridioides difficile infection (CDI) in a long-term hospital is key to improve its management. METHODS: Retrospective study with 37 patients, along 43 months. We describe demographic variables, clinical data, time to diagnosis, treatment, and evolution. RESULTS: Analysis of 46 episodes (37 patients, mean age=82.2 years). 77.8% were absolutely dependent, 41.7% had chronic kidney disease, 64.9% had received antibiotics in the previous three months, 40.5% received antibiotics at diagnosis. It was the first episode in 78.4%, and first recurrence in 21.6%. Therapy was started in the first 24 hours after diagnosis in 89.2%, mostly metronidazole. 83.3% recovered, 3 patients died from CDI, diagnosis was registered in the discharge report in 91.1%. CONCLUSIONS: Previous antibiotic therapy, high grade of dependency and renal failure were the main risk factors. There is room for improvement in CDI management at our hospital.

Valor de la circometría en el diagnóstico de la trombosis venosa profunda en pacientes con lesión medular / Utility of circometry in the diagnosis of deep venous thrombosis in patients with a spinal cord injury

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Voluntary alcohol intake after noise exposure in adolescent rats: Hippocampal-related behavioral alterations.

Different physical or chemical agents, such as noise or alcohol, can induce diverse behavioral and biochemical alterations. Considering the high probability of young people to undergo consecutive or simultaneous exposures, the aim of the present work was to investigate in an animal model if noise exposure at early adolescence could induce hippocampal-related behavioral changes that might be modified after alcohol intake. Male Wistar rats (28-days-old) were exposed to noise (95-97 dB, 2 h). Afterwards, animals were allowed to voluntarily drink alcohol (10% ethanol in tap water) for three consecutive days, using the two-bottle free choice paradigm. After that, hippocampal-related memory and anxiety-like behavior tests were performed. Results show that whereas noise-exposed rats presented deficits in habituation memory, those who drank alcohol exhibited impairments in associative memory and anxiety-like behaviors. In contrast, exposure to noise followed by alcohol intake showed increases in exploratory and locomotor activities as well as in anxiety-like behaviors, unlike what was observed using each agent separately. Finally, lower levels of alcohol intake were measured in these animals when compared with those that drank alcohol and were not exposed to noise. Present findings demonstrate that exposure to physical and chemical challenges during early adolescence might induce behavioral alterations that could differ depending on the schedule used, suggesting a high vulnerability of rat developing brain to these socially relevant agents.

[Involvement of the spinal cord in rheumatoid arthritis]. / Afectacion medular en la artritis reumatoide.

TITLE: Afectacion medular en la artritis reumatoide.

Use of antibiotics and the prevalence of antibiotic-associated diarrhoea in patients with spinal cord injuries: an international, multi-centre study.

BACKGROUND: Little is known about the use of antibiotics and the extent of antibiotic-associated diarrhoea (AAD) in patients with spinal cord injuries (SCIs). AIMS: To record the use of antibiotics, establish the prevalence of AAD and Clostridium difficile infection (CDI), and assess if there was any seasonal variation in antibiotic use and incidence of AAD in patients with SCIs. METHODS: A retrospective study was conducted in six European SCI centres between October 2014 and June 2015. AAD was defined as two or more watery stools (Bristol Stool Scale type 5, 6 or 7) over 24 h. FINDINGS: In total, 1267 adults (median age 54 years, 30.7% female) with SCIs (52.7% tetraplegia, 59% complete SCI) were included in this study. Among the 215 (17%) patients on antibiotics, the top three indications for antibiotics were urinary tract infections (UTIs), infected pressure ulcers and other skin infections. Thirty-two of these 215 (14.9%) patients developed AAD and two patients out of the total study population (2/1267; 0.16%) developed CDI. AAD was more common in summer than in spring, autumn or winter (30.3% vs 3.8%, 7.4% and 16.9%, respectively; P<0.01). AAD was associated with age ≥65 years, tetraplegia, higher body mass index, hypoalbuminaemia, polypharmacy, multiple antibiotic use and high-risk antibiotic use. Summer and winter seasons and male sex were identified as independent predictors for the development of AAD. CONCLUSION: This survey found that AAD is common in patients with SCIs, and UTI is the most common cause of infection. Summer and winter seasons and male sex are unique predictors for AAD. Both AAD and UTIs are potentially preventable; therefore, further work should focus on preventing the over-use of antibiotics, and developing strategies to improve hospital infection control measures.

An intermediate respiratory care unit for spinal cord-injured patients. A retrospective study.

OBJECTIVES: Patients with cervical spinal cord injury (SCI) may need prolonged mechanical ventilation (MV) and a long stay in the Intensive Care Unit. An intermediate respiratory care unit (IRCU) can shorten that stay, optimizing hospital resources. The aim of our work has been to evaluate the activity of such a unit in our hospital. METHODS: This is a descriptive retrospective study based on the data of patients with SCI and respiratory failure discharged from our IRCU between 1 July 2010 and 28 February 2013. RESULTS: We have analysed data from 146 patients with SCI, adding up to 228 admissions (68 first admissions and 160 readmissions due to complications or scheduled review visits). Sixty-three out of the 68 newly admitted patients survived their first admission (92.6%). Length of hospitalization was 195.6±110.4 days, 22 were admitted to monitor their respiratory status and 46 were on MV on admission. Of these, 26 (38.2%) were admitted to attempt weaning from the respirator and 20 (29.4%) to enter a programme of permanent respiratory support. Weaning was successful in 23 out of 26 patients (88.4%), the process taking 47.2±49.3 days. Forty of them (58.8%) were discharged to their home. CONCLUSIONS: An IRCU can manage a substantial number of severe SCI patients who need MV, and an important number of them can be weaned from the respirator. It may also achieve a good success rate in the integration of MV-dependent patients within family and society.

Long-term evaluation of phrenic nerve pacing for respiratory failure due to high cervical spinal cord injury.

OBJECTIVES: Phrenic nerve pacing is a method of respiratory support that can replace mechanical ventilation in high-level cervical spinal cord injury patients with diaphragmatic paralysis. Our objective was to evaluate survival and long-term quality of life in patients with external respiratory support by PNP vs volumetric respirator in patients with severe respiratory insufficiency due to a high-level spinal cord injury. DESIGN: This is a retrospective review study of a prospectively collected database for evaluate the survival and a questionnaire for quality of life has been collected face-to-face or by telephone at present. PATIENTS: Cervical SCI patients with permanent respiratory support (PNP or MV). METHODS: Long-term evaluation of a cohort of PNP-supported patients. We performed a comparison between these patients and volumetric respirator-supported patients. For survival analysis, we used the Kaplan-Meier method and Cox proportional hazards model. The health-related quality of life was assessed with SF-36 questionnaire, a general HRQL evaluation. RESULTS: One hundred twenty six patients on permanent respiratory support were evaluated during the study period. Of these, 38 were on PNP and 88 were mechanically ventilated. Paced patients were younger and had a longer survival, but in a multivariate analysis adjusted for age using a multiple logistic correlation we found that length of survival was greater for PNP patients. In terms of HRQL, the PNP-supported patients showed better results in terms of social functioning. CONCLUSIONS: PNP is a stable and effective method of long-term respiratory support in this type of patients (SCI patients dependent on external respiratory support). In these patients it improves the length of survival and some social issues by quality of life when compared with patients under MV.

Marine reserves: fish life history and ecological traits matter.

Marine reserves are assumed to protect a wide range of species from deleterious effects stemming from exploitation. However, some species, due to their ecological characteristics, may not respond positively to protection. Very little is known about the effects of life history and ecological traits (e.g., mobility, growth, and habitat) on responses of fish species to marine reserves. Using 40 data sets from 12 European marine reserves, we show that there is significant variation in the response of different species of fish to protection and that this heterogeneity can be explained, in part, by differences in their traits. Densities of targeted size-classes of commercial species were greater in protected than unprotected areas. This effect of protection increased as the maximum body size of the targeted species increased, and it was greater for species that were not obligate schoolers. However, contrary to previous theoretical findings, even mobile species with wide home ranges benefited from protection: the effect of protection was at least as strong for mobile species as it was for sedentary ones. Noncommercial bycatch and unexploited species rarely responded to protection, and when they did (in the case of unexploited bentho-pelagic species), they exhibited the opposite response: their densities were lower inside reserves. The use of marine reserves for marine conservation and fisheries management implies that they should ensure protection for a wide range of species with different life-history and ecological traits. Our results suggest this is not the case, and instead that effects vary with economic value, body size, habitat, depth range, and schooling behavior.

Síndrome general solitario: ¿estamos de acuerdo en el nombre? / General lonely syndrome, are we in agrement with the denomination?

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Cálculo vectorial in vitro de las fuerzas de cizallamiento y compresión en la cadera del niño / Vectorial calculations in vitro of shears and compression forces in teh infantile HIP

Objetivo: Estudiar in vitro las magnitudes vectoriales de las fuerzas de cizallamiento y compresión en el acetábulo y el fémur proximal en la cadera infantil. Diseño experimental: Se efectuaron cálculos con ecuaciones trigonométricas con las variables: índice acetabular, ángulo fisario de Alsberg y peso corporal medio a los 7 y 12 meses de edad, tanto en a) bipedestación estática como en b) apoyo monopodal. Todo ello con 3 coeficientes de fricción: 0; 0,3 y 0,6. Resultados: En el acetábulo, las fuerzas de cizallamiento, aumentaron un 41 por ciento entre los 0° y los 40° en bipedestación estática y 40 por ciento y 69 por ciento entre 20° a 25° y 35° a 40°, respectivamente, durante el apoyo monopodal. Las de compresión disminuyeron un 4 por ciento entre 0° y 40°, 1 por ciento de 0° a 15° y 2 por ciento de 15° a 40° con la bipedestación, doblando casi su magnitud en el apoyo monopodal. Las fuerzas de cizallamiento fueron la cuarta parte de las de compresión en bipedestación y apoyo monopodal. En el fémur proximal, las fuerzas de cizallamiento aumentaron 24 por ciento entre 90° y 0°, (60 por ciento entre 70°-65°) en bipedestación y 11,5 por ciento, entre 75° y 70° del ángulo fisario, todo ello con apoyo monopodal. Las de compresión aumentaron un 12 por ciento globalmente, pero sólo el 2 por ciento entre 75° y 90° en bipedestación, incrementándose un 6,4 por ciento en apoyo monopodal, pero con descenso de su magnitud entre 75° y 90°. El cizallamiento dobló en el fémur proximal a la compresión, especialmente en bipedestación, pero sólo fue un 4 por ciento mayor en 60° del ángulo fisario en apoyo monopodal. Conclusión: La morfología normal del acetábulo y el fémur proximal, parecen ajustarse a evitar grandes magnitudes vectoriales de cizallamiento y compresión. (AU)

Prótesis total versus artroplastia ligamentosa en la cirugía de la rizartrosis / Total prosthesis versus ligamentous arthroplasty in surgery for rhizoarthrosis

Se ha realizado un estudio prospectivo comparativo del tratamiento quirúrgico de la rizartrosis mediante dos técnicas: prótesis total no cementada y artroplastia con interposición tendinosa y reconstrucción del ligamento.Se seleccionaron los pacientes consecutivos, mujeres, con edad entre 45 y 70 años y tratamiento conservador previo durante al menos un año. Aleatoriamente se les trató con una de las dos técnicas. Resultó una muestra de 21 pacientes, 10 tratados mediante prótesis total no cementada y los restantes 11 mediante trapecectomía e interposición y reconstrucción ligamentosa.Entre ambos grupos no había diferencias significativas respecto a los datos preoperatorios. Pre y postoperatoriamente se evaluaron el dolor, actividades cotidianas, movilidad y análisis radiográfico. El seguimiento postoperatorio medio fue de 37 meses.Los peores resultados funcionales se encontraron en el grupo de las prótesis, con sólo el 30 por ciento de resultados excelentes o buenos frente al 81,9 por ciento del grupo de interposición ligamentosa; los resultados radiográficos fueron también peores en el primero. En el grupo de prótesis se presentaron 6 casos con complicaciones: una infección, 3 aflojamientos del componente trapecial, una rotura del mismo y un desamblaje de ambos componentes; en el otro grupo hubo dos complicaciones: un colapso del metacarpiano y un caso de calcificaciones periarticulares. Los pacientes reintervenidos o susceptibles de cirugía de revisión fueron el 40 por ciento en el grupo de prótesis, frente a ninguno en el otro grupo (AU)

[Amebic liver abscess: review of 13 cases]. / Absceso hepático amebiano: revisión de 13 casos.

Amebian hepatic abscess (AHA) is the most frequent extraintestinal localization of infection by Entamoeba histolytica. Despite being a disease mainly of tropical zones, it is currently also observed with higher frequency in Spain. Thirteen cases of AHA diagnosed in the authors' hospital over the last 11 years were retrospectively analyzed comparing the data in this series with that of other published series and undertaking a review of this subject. The diagnosis of AHA was established on the basis of the clinical picture together with specific positive serology and compatible echographic imaging. The series was composed of 9 males and 4 females with a mean age of 38.7 years (range 25-55). Five were Spanish, and 8 were immigrants from tropical countries. In 61.5% of the cases echographically guided aspiration puncture was performed with placement of percutaneous drainage being carried out in 38%. Eighty-five percent of patients were treated with more than one amebicide drug (metronidazole or tinidazole together with chloroquine and dehydroemetine). Luminal amebicides were administered lastly. Laparotomy was required in 3 cases due to the presence of complications. No deaths were observed.