Assessment of university policies for service animals and emotional support animals.

OBJECTIVE: Assess administrative responsibilities and experiential effects of emotional support animal (ESA) and service animal (SA) policies on college campuses. PARTICIPANTS: Students at two four-year universities participated in an emotional support animals and service animals survey. Selected students and professional personnel participated in interviews and focus groups. METHODS: This mixed-methods study included quantitative survey data from 1,363 students, qualitative individual interviews (3) and a focus group (1) regarding emotional support animal (ESA) and service animal (SA). RESULTS: Seventy-one students reported having ESAs, 18 had SAs. Barriers for ESAs on campus included no ESAs outside of dorms, while SA-owners reported fewer barriers. University administrators followed federal guidelines for SAs but lacked clear guidelines for ESAs. Qualitative themes included lack of awareness, education, support for SA, and ESA accommodations. CONCLUSIONS: ESA and SA accommodations continue to rise, on university campuses. Clear guidelines and implementation processes are imperative for future improvements.

Establishing the tolerability to broiler chickens and laying hens of nonanoic acid at practical levels of use as a feed flavouring.

1. The following experiments were conducted to evaluate the effects of nonanoic acid (NA) in broilers and laying hens, at practical levels as a flavouring in complete feed.2. In the first experiment, 1100, one-day-old Ross 308 chicks, half male and female, were randomly assigned to 50 floor pens containing 22 chicks each. Chicks were fed one of five treatment diets containing either 0 (control), 100, 300, 500 or 1,000 mg NA/kg complete feed for 42 days.3. The NA treatment had no effect on ADFI, but there was a linear relationship with ADG and FCR. No differences were observed in blood parameters or tissue pathology among treatment groups.4. In a second study, 150 Hyline hens aged 24 weeks old were randomly assigned to 50 pens containing three birds each. Laying hens were fed one of five treatment diets containing 0 (control), 100, 300, 500 or 1,000 mg NA/kg complete feed for 56 days.5. Treatment with NA has no effect on live weight, ADFI or egg production in laying hens, and there were no observed changes in tissue pathology.6. The results supported the toleration of NA in broilers or layers at dietary levels of up to 1,000 mg/kg.

A ten-year monitoring of essential and non-essential elements in the dolphinfish Coryphaena hippurus from the southern Gulf of California.

The concentrations of As, Cd, Cu, Pb and Zn were measured in muscle tissue of Coryphaena hippurus captured in the southern Gulf of California to determine inter-annual variations and their relation with environmental parameters for the period 2006-2015; additionally, health risk to consumers was assessed according to levels of studied elements and rate of fish consumption in northwest Mexico. During 2014 and 2015 the levels of As, Cd, Cu, and Zn were significantly lower than the rest of the years; in the case of As, it was also significantly lower in 2010. Oceanic Niño Index was negatively correlated with Zn concentrations in fish, while sea surface temperature was negatively correlated with Zn, Pb and Cd concentrations in dolphinfish. The simultaneous occurrence of the analyzed elements in muscle of dolphinfish indicated that health effects on consumers are not likely to occur; nevertheless, fishermen with elevated fish consumption might be at risk.

Effect of an abdominal hypopressive technique programme on pelvic floor muscle tone and urinary incontinence in women: a randomised crossover trial.

OBJECTIVES: To test the effect of a structured abdominal hypopressive technique (AHT) programme on pelvic floor muscle (PFM) tone and urinary incontinence (UI) in women. DESIGN: Crossover trial with random assignment of women to one of two groups: Group 1 (AHT followed by rest) and Group 2 (rest followed by AHT). SETTING: Two cultural centres in Madrid, Spain. PARTICIPANTS: Women aged 20-65 years. INTERVENTIONS: Two months of supervised AHT exercises compared with 2 months of rest. MAIN OUTCOME MEASURES: Variation in PFM tone and score on the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF)]. RESULTS: Forty-two women were randomised to two groups (both n=21). No sequence or period effect was noted. The mean difference in PFM tone after the 2-month AHT programme was 59g/cm² [95% confidence interval (CI) 37 to 82]; the between-group difference was 83g/cm² (95% CI 50 to 116; P<0.001). After 2 months, the between-group difference in the ICIQ-SF score was 3.3 points (P<0.001). The majority of participants reported improved body image and sense of well-being. CONCLUSIONS: A structured 2-month AHT programme for women showed short-term benefits in PFM tone and UI. In addition, study participants reported improved body image and sense of well-being, and programme satisfaction, as demonstrated by questionnaire at the end of the intervention period. Further research is needed to test the long-term effects and effectiveness of AHT compared with other PFM exercises. ClinicalTrials.gov Identifier NCT0221241.

Theory of Planned Behavior and Perceived Role Model as Predictors of Nutrition and Physical Activity Behaviors Among College Students in Health-Related Disciplines.

Physical activity (PA) and nutrition behaviors among college students in health-related disciplines are understudied. We used theory of planned behavior (TPB) and role model beliefs (RMB) to predict PA and eating behaviors of college students in health-related programs (nurses, physical education, exercise science, and athletic training). A 26-item survey was administered among the participants. Independent variables included TPB constructs and RMB measured on a 5-point scale. PA was measured by multiplicative scores of students' number of days by the amount of time spent exercising per week. Nutrition behavior was measured using fruits (2½ c-eq/day), vegetables (2½ c-eq/day), dairy (2 c-eq/day), grains (6 oz-eq/day), and proteins (5½ oz-eq/day). Multiple regression analyses were used to predict PA and nutrition behaviors. A total of 271 college health majors (mean age 22.5 ± 4.6 years) participated in the study. The majority (56.8%) of students did not meet the weekly PA guidelines and 43.2% did not meet the recommended dietary guidelines for daily servings of food groups combined. Regression analyses showed that outcome evaluation, behavioral belief, and RMB, were significantly related with student's PA behavior and they accounted for 34%, 8%, and 1% of the variance, respectively (total R2 = 44.7). Outcome evaluation and behavioral beliefs were significantly related with nutritional behavior and they accounted for 13.3%, and 5.3% of the variance respectively (total R2 = 18.6). TPB (outcome evaluation, behavioral belief) and RMB could be used to guide programs in promoting PA and nutrition behavior among college health majors.

Reduced work/academic performance and quality of life in patients with allergic rhinitis and impact of allergen immunotherapy.

BACKGROUND: Allergic rhinitis (AR) is characterised by burdensome nasal and/or ocular symptoms. This inflammatory disease can be debilitating and thus result in considerable health-related and economic consequences. METHODS: In a cross-sectional study, adult subjects with AR (N = 683) completed three allergy-specific questionnaires that assessed the impact of AR on the work/academic performance, daily activities, health-related quality of life (HRQOL), and satisfaction with allergen immunotherapy (AIT). Regression analyses were used to examine the associations between several clinical variables and the patient-reported outcomes. RESULTS: Total loss of productivity was 21.0 and 21.2 % for employed and student patients, respectively, whereas the impairment of daily activities was 22.0 %. The mean overall HRQOL score was 1.94 ± 1.29 (on the scale of 0-6 points). Global score for satisfaction with AIT was 65.5 ± 24.8 (on a 0-100 scale). Simple regression analysis found statistically significant associations between loss of work and academic productivity, impairment of daily activities and the type and severity of AR. AIT was a protective factor. The persistent and more severe types of AR and lack of AIT contributed to the worsening of HRQOL. CONCLUSIONS: AR (the persistent and more severe form of the disease) has an impact on functional characteristics of adult patients in Spain. AIT might reduce the effect of this disease on the work/academic performance and HRQOL. Trial registration Retrospectively registered.

Efficacy of feed additives against Campylobacter in live broilers during the entire rearing period: Part B.

A total of 636 day-of-hatch Ross 308 broilers chicks were used in 4 independent trials carried out to screen the effect of 12 feed additives on reducing cecal colonization of Campylobacterin broilers. The tested additives were probiotics based on B. subtilis and S. cerevisae, a garlic extract, a blend of herbal substances and essential oils, two different combinations of essential oils and organic acids (OA), two mixtures of flavoring compounds, medium chain fatty acids (MCFA), monoglycerides (MG) of MCFA and MG-MCFA+OA. At 14 days of age, all the birds were orally infected with 0.1 mL of a bacterial suspension of C. jejuni ST-45 diluted at 10(5) cfu/mL in tryptone salt broth. In each trial, there was a positive control group and 2 (Trials 1 and 2) or 4 (Trials 3 and 4) additional treatment groups supplemented with additives, which were added to feed or water only to the finisher (21 to 42 d) diet (Trials 1 and 2) or to the starter (0 to 21 d) and finisher diets (Trials 3 and 4). Feed and water were available ad libitum. On days 35 and 42 of age in Trials 1 and 2, and on days 21, 35 and 42 of age in Trials 3 and 4, 10 (Trials 1 and 2) or 12 birds (Trials 3 and 4) per group were euthanized for cecal sampling. In Trial 1, birds fed with MCFA and MG-MCFA had a significant (P<0.05) reduction in cecal Campylobacter colonization compared to control at 35 d, but only the group treated with MG-MCFA maintained the reduction at 42 d. In Trials 2 to 4, no significant differences (P>0.05) in cecal Campylobacter counts were found between the treated and control animals. In conclusion, although none of the treatments were able to completely prevent the colonization of chickens with C. jejuni, MCFA and MG-MCFAs could reduce the pathogen counts when supplemented from 21 days onwards.

Effects of oral salt supplementation on physical performance during a half-ironman: A randomized controlled trial.

The aim of this study was to investigate the effectiveness of oral salt supplementation to improve exercise performance during a half-ironman triathlon. Twenty-six experienced triathletes were matched for age, anthropometric data, and training status, and randomly placed into the salt group (113 mmol Na(+) and 112 mmol Cl(-)) or the control group (cellulose). The experimental treatments were ingested before and during a real half-ironman triathlon competition. Pre- and post-race body mass, maximal force during a whole-body isometric strength test, maximal height during a countermovement jump, were measured, and blood samples were obtained. Sweat samples were obtained during the running section. Total race time was lower in the salt group than in the control group (P = 0.04). After the race, whole-body isometric strength (P = 0.17) and jump height (P = 0.49) were similarly reduced in both groups. Sweat loss (P = 0.98) and sweat Na(+) concentration (P = 0.72) were similar between groups. However, body mass tended to be less reduced in the salt group than in the control group (P = 0.09) while post-race serum Na(+) (P = 0.03) and Cl(-) (P = 0.03) concentrations were higher in the salt group than in the control group. Oral salt supplementation was effective to lessen body mass loss and increase serum electrolyte concentration during a real half-ironman.

ß-Cryptoxanthin modulates the response to phytosterols in post-menopausal women carrying NPC1L1 L272L and ABCG8 A632 V polymorphisms: an exploratory study.

Phytosterol (PS) intake may be used for hypercholesterolaemia in some groups although the presence of non-responders is well known. Carotenoids and PS/cholesterol may compete for the same transporters during absorption. As part of a randomized, double-blind, crossover, multiple-dose supplementation study with ß-cryptoxanthin (ß-Cx) and PS, single and combined, polymorphisms of ABCG8 (A632V) and NCPL1 (L272L) were determined in 19 post-menopausal women. Subjects carrying CC polymorphism for NCP1L1 (L272L) showed a net increase in total cholesterol and LDL after PS intake but, interestingly, displayed a decrease in both lipid fractions after consuming PS plus ß-Cx. For the ABCG8 (A632V) gene, CT/TT carriers consuming PS also displayed an increase in total cholesterol and LDL, but this increment was much lower after the intake of PS plus ß-Cx. Additionally, in CC carriers for ABCG8 (A632V), a greater decrease in total cholesterol and LDL was found after the intake of PS plus ß-Cx compared to that observed after PS alone. Overall, our results suggest that ß-Cx improves the response to PS in individuals carrying specific genetic polymorphisms (i.e. non-responders), opening the possibility to modulate the response to PS by food technology. (ClinicalTrials.gov NCT01074723).

Colecistectomía transumbilical mediante técnica híbrida: un nuevo abordaje prometedor / Transumbilical cholecystectomy using hybrid technique: A new promising approach

Objetivos. La utilización de imanes en la colecistectomía transumbilical mejora la triangulación y logra una visión crítica óptima. No obstante, la atracción entre los imanes puede provocar colisiones y su manejo dificulta el proceso, siendo este hecho más relevante en pediatría. Con el objetivo de simplificar la técnica y disminuir la curvad e aprendizaje, hemos elaborado un modelo híbrido con un solo imán. Material y métodos. Revisión retrospectiva de las colecistectomías realizadas en nuestro servicio entre junio 2011 y julio 2012. La técnica combina el uso de un imán y una pinza curva. A través de la incisión transumbilical, colocamos un trocar de 12 mm y otro flexible de 5 mm. Por el primero introducimos el imán encargado de traccionar del fundusvesicular y el laparoscopio con canal de trabajo. El trocar flexible se usa para la pinza curva, manejada por el ayudante para movilizar el infundíbulo. El cirujano opera por el canal de trabajo del laparoscopio. Resultados. Veintiséis pacientes fueron intervenidos con esta técnica. La edad media fue 14 años (4-17) y el peso 50 kg (18-90), siendo el 65% niñas. El tiempo operatorio medio fue 62 minutos (50-70) y la visión crítica de seguridad se logró en todos los casos. No hubo entrecruzamientos de las pinzas ni de las manos de los cirujanos. No existieron complicaciones intraoperatorias ni postoperatorias. La estancia hospitalaria fue 1,4 ± 0,6 días y la mediana de seguimiento 201 días (42-429).Conclusiones. La técnica hibrida, combinando imán y pinza curva, simplifica la cirugía transumbilical. Parece una alternativa factible y segura para la colecistectomía transumbilical y potencialmente reproducible (AU)

Objectives. The use of magnets in transumbilical cholecystectomy improves triangulation and achieves optimal critical view. However, theattraction between magnets can cause collisions and their management complicates the procedure, and this will become more important in children. In order to simplify the technique, we have developed a hybrid model with a single magnet. Material and methods. Retrospective review of cholecystectomies performed in our department between June 2011 and July 2012. The technique combines the use of a magnet and a curved (..) (AU)

[Transumbilical cholecystectomy using hybrid technique: a new promising approach]. / Colecistectomia transumbilical mediante técnica híbrida: un nuevo abordaje prometedor.

OBJECTIVES: The use of magnets in transumbilical cholecystectomy improves triangulation and achieves optimal critical view. However, the attraction between magnets can cause collisions and their management complicates the procedure, and this will become more important in children. In order to simplify the technique, we have developed a hybrid model with a single magnet. MATERIAL AND METHODS: Retrospective review of cholecystectomies performed in our department between June 2011 and July 2012. The technique combines the use of a magnet and a curved grasper. Through transumbilical incision, a 12 mm trocar and another flexible 5 mm are placed. Laparoscope with working channel uses the 12 mm trocar. The magnet is introduced to the abdominal cavity using the working channel to provide cephalad retraction of gallbladder fundus. Curved grasper is run by the assistant to mobilize the infundibulum across flexible trocar. The surgeon operates through the working channel of the laparoscope. RESULTS: Twenty-six patients were operated on with this technique. Mean age was 14 years (4-17) and weight 50 kg (18-90). 65% were girls. The mean operative time was 62 minutes (50-70) and the critical view of safety was achieved in all cases. Instrumental collision or hands crossing were not seen. There were no intraoperative or postoperative complications. The hospital stay was 1.4 +/- 0.6 days and the median follow-up 201 days (42-429). CONCLUSIONS: The hybrid technique, combining magnet and a curved grasper, simplifies transumbilical surgery. It seems a feasible and safe for transumbilical cholecystectomy and potentially reproducible.

Cambios mínimos esofágicos: ¿desapercibidos en la video endoscopia de pacientes con enfermedad de reflujo gastroesofágico no erosiva? / Esophagus minimal changes: unobserved in the video-endoscopy of patients with non erosive gastroesophageal reflux?

La mayoría de pacientes con enfermedad de reflujo gastroesofágico no tienen lesiones erosivas en esófago. Los cambios mínimos esofágicos que incluyen alteraciones blancas, rojizas, edematosas y/o acantósicas usualmente no percibidos durante la endoscopia se incluyen en Japón como parte de la enfermedad de reflujo no erosiva. Previo consentimiento se incluyeron a los individuos con síntomas de reflujo gastroesofágico y se compararon con un grupo sin éstos. Se utilizó equipo Fujinon HR250. La endoscopia se grabó en DVD y de rutina se fotografió la unión Esófago Gástrica y la Escamo Columnar. Se empleó la clasificación de Los Ángeles modificada por los japoneses que incluye Cambios Mínimos Esofágicos. Se practicó endoscopia digestiva superior en 146 pacientes 86 hombres y 60 mujeres con rango de edad 15-83 años y promedio 38,71 años. Se diferenciaron tres grupos: I) Sin cambios esofágicos, II) Con cambios esofágicos erosivos y III) Con cambios mínimos esofágicos. Los Cambios Mínimos Esofágicos se pudieron haber reportado en 53,44% y en 36,66% de pacientes con y sin síntomas de reflujo gastroesofágico respectivamente. Los Cambios Mínimos Esofágicos son frecuentes y pasan desapercibidos si no sabemos que investigar y no insistimos en buscarlos en pacientes con Enfermedad de Reflujo No Erosiva...

Most patients diagnosed with gastroesophageal reflux disease do not show erosive lesions in the esophagus. The esophagus minimal changes, which include white, reddish, edematous and/or acanthotic disturbances, are usually not perceived during endoscopic procedure and in Japan are included as part of the non erosive reflux disease. With prior consent, subjects with symptoms of gastroesophageal reflux were included, and were compared with a group without said symptoms. Fujinon HR250 equipment was used. The endoscopy was recorded on DVD and, routinely, photographs of the gastroesophageal and the squamous columnar junctions were taken. Los Angeles classification was used, as modified by the Japanese which includes Esophagus Minimal Changes. Upper digestive endoscopy was used in 146 patients: 86 men and 60 women, with ages ranging between 15 and 83, and an average of 38.71. Three groups were distinguished: I) Without changes in the esophagus; II) With erosive changes in the esophagus; and III) With esophagus minimal changes. Esophagus Minimal Changes might be reported in 53.44% and in 36.66% of patients with and without gastroesophageal reflux symptoms, respectively. Esophagus Minimal Changes are frequent but are unobserved if researcher does not know what the investigation must be on and if researcher does not insist in looking for them in patients with a diagnosis of Non Erosive Reflux Disease...

Triple terapia en diabetes tipo 2: revisión sistemática de la evidencia disponible / Triple therapy in type 2 diabetes: systematic review of the available evidence

Las guías terapéuticas actuales difieren en las recomendaciones para la triple terapia cuando no se consiguen los objetivos con el tratamiento combinado dedos agentes orales. También difieren en el tipo de asociación y en la denominación de triple terapia. En el presente trabajo se realiza una revisión de la evidencia científica existente para determinar si la triple terapia es eficaz y segura, así como la asociación más favorable en el paciente con diabetes tipo 2. Revisando los estudios disponibles, se observa que la triple terapia mejora el control glucémico. Sin embargo, los ensayos clínicos aleatorizados disponibles en general no exceden el año de seguimiento, y no ofrecen datos sobre variables finales como morbilidad y mortalidad. En consecuencia, hasta el momento el beneficio a largo plazo y la seguridad de una triple terapia no están demostrados. En conclusión, con los datos disponibles actualmente no hay razón para retrasar la introducción de la insulina en el tratamiento de los pacientes con diabetes tipo 2 tras el fracaso de una terapia combinada doble, excepto en los casos de resistencia de los pacientes al inicio de la insulinización(AU)

Current guidelines differ in their recommendations for triple therapy when targets are not achieved with a combined treatment of two oral agents. In addition, they diverge also in the type of association and the name given for the triple therapy. In the present manuscript we review the available scientific evidence to determine whether triple therapy is effective and safe, as well as themore favorable association in patients with type 2 diabetes. Reviewing available literature, we have noticed that triple therapy improves glycemic control. However, available randomized control trials do not extend more than one year of follow-up and they don’t have data over endpoint variables as morbidity and mortality. Therefore, the long-term safety of triple therapy has not been demonstrated until now. In conclusion, with the currently available data there is no reason to delay introduction of insulin in the treatment of patients with type 2diabetes after failure of dual combination therapy, except in cases of patients’ resistance to initiate insulin therapy(AU)

[Efficacy of recombinant activated factor VII for massive bleeding after cardiac surgery: experience with 32 patients]. / Eficacia del factor VII recombinante activado en el tratamiento de la hemorragia masiva en el postoperatorio de cirugía cardiaca: experiencia en 32 pacientes.

OBJECTIVE: To determine the efficacy of recombinant activated factor VII (rFVIIa) to treat massive bleeding refractory to conventional treatment following cardiac surgery. PATIENTS AND METHODS: Retrospective study of 32 adults who underwent cardiac surgery and received rFVIIa to treat life-threatening postoperative bleeding after conventional means of correcting coagulopathy had failed. RESULTS: After administration of rFVIIa (90 microg x kg(-1), coagulation parameters soon became normal and blood loss decreased, with drainage going from a mean (SD) of 463 (321) mL in the hour when rFVIIa was infused to 155 (101) mL in the next hour (P < .001). Blood loss decreased by between 22% and 90% (mean, 66%), and the reduction was over 75% in 45% of the patients. Decreases in the transfusion of packed red blood cells (from 7A.4 [4.1] units to 2.7 [ 2.9] units; P < .001), plasma (from 4.7 [2.9] units to 1.6 [2.0] units; P < .001), and platelets were also noted. Mortality was 25%, although only 1 patient died from hemorrhagic shock. One patient developed thromboembolic complications (ischemic stroke). CONCLUSION: rFVIIa was effective in treating refractory bleeding after cardiac surgery, reducing blood loss and transfusion requirements and restoring blood parameters to normal.

Establecimiento de las condiciones de la mezcla de la pulpa de banano (Musa paradisiaca L) para someter a secado por aspersión / Establishing of the conditions of the blend of pulp with banana (Musa paradisiaca L) to submit spray dryng

El secado por aspersión es uno de los métodos más empleados para deshidratar alimentos y prolongar su vida útil. En este trabajo se pretende determinar las cantidades óptimas de maltodextrina y goma acacia a utilizar para maximizar ºBrix y minimizar la viscosidad en pulpa de banano para su posterior secado por aspersión. La maltodextrina es significativa tanto para el contenido en ºBrix como para la viscosidad, pero a esta última también la afecta la interacción entre maltodextrina y goma acacia. Es necesario encontrar un equilibrio entre el máximo de ºBrix y una mínima viscosidad, pues una viscosidad baja permite una mejor fluidez de la mezcla en el sistema de atomización (disco o difusor), y una alta concentración de sólidos totales incrementa el rendimiento del producto final. La combinación que genera la mejor respuesta es 39,95 g maltodextrina con 3,29 g de goma arábiga. Con esta combinación de tratamientos se encuentra el punto donde los ºBrix son máximos y la viscosidad es mínima encontrándose un valorde 46,44 ºBrix y 634,59 cP respectivamente.

Eficacia del factor VII recombinante activado en el tratamiento de la hemorragia masiva en el postoperatorio de cirugía cardiaca: experiencia en 32 pacientes / Efficacy of recombinant activated factor VII for massive bleeding after cardiac surgery: experience with 32 patients

OBJETIVOS: Estudiar la eficacia del factor VII recombinanteactivado (rFVIIa) en el tratamiento de la hemorragiamasiva refractaria a las medidas convencionalesen el postoperatorio de cirugía cardiaca.PACIENTES Y MÉTODOS: Se estudiaron retrospectivamente32 pacientes adultos sometidos a cirugía cardiaca,que recibieron rFVIIa como tratamiento de la hemorragiapostoperatoria cuando se estimó que ésta suponíauna amenaza vital, y habían fracasado las medidas convencionalesorientadas a la corrección de la coagulopatía.RESULTADOS: La administración del rFVIIa (90 μg Kg-1) fue seguida de una rápida normalización de los parámetrosde coagulación y de una reducción en el débitohemático por los drenajes, que pasó de una media de463 ± 321 ml en la hora de la administración del fármacoa 155 ± 101 ml en la hora posterior (p < 0,001). Todos lospacientes presentaron una disminución de las pérdidashemáticas en esta primera hora, con reducciones que oscilaronentre el 22% y el 90% (media 66%), siendo superioresal 75% en un 45% de los pacientes. También seobservó una disminución en la transfusión de concentradosde hematíes (de 7,4 ± 4,1 unidades a 2,7 ± 2,9;p < 0,001), plasma (de 4,7 ± 2,9 unidades a 1,6 ± 2,0;p < 0,001) y plaquetas. La mortalidad fue del 25%, aunquesólo un paciente falleció por shock hemorrágico. Unpaciente presentó complicaciones tromboembólicas (ictusisquémico cerebral).CONCLUSIONES: El rFVIIa fue eficaz en el tratamiento dela hemorragia refractaria tras cirugía cardiaca, reduciendolas pérdidas hemáticas, las necesidades transfusionales ynormalizando precozmente los parámetros analíticos(AU)

OBJECTIVE: To determine the efficacy of recombinantactivated factor VII (rFVIIa) to treat massive bleedingrefractory to conventional treatment following cardiacsurgery.PATIENTS AND METHODS: Retrospective study of 32adults who underwent cardiac surgery and receivedrFVIIa to treat life-threatening postoperative bleedingafter conventional means of correcting coagulopathy hadfailed.RESULTS: After administration of rFVIIa (90 μg·kg-1),coagulation parameters soon became normal and bloodloss decreased, with drainage going from a mean (SD) of463 (321) mL in the hour when rFVIIa was infused to155 (101) mL in the next hour (P<.001). Blood loss decreasedby between 22% and 90% (mean, 66%), and thereduction was over 75% in 45% of the patients. Decreasesin the transfusion of packed red blood cells(from 7.4 [4.1] units to 2.7 [2.9] units; P<.001), plasma(from 4.7 [2.9] units to 1.6 [2.0] units; P<.001), and plateletswere also noted. Mortality was 25%, although only1 patient died from hemorrhagic shock. One patientdeveloped thromboembolic complications (ischemic stroke).CONCLUSION: rFVIIa was effective in treating refractorybleeding after cardiac surgery, reducing blood lossand transfusion requirements and restoring blood parametersto normal(AU)

Obliquity-paced Pliocene West Antarctic ice sheet oscillations.

Thirty years after oxygen isotope records from microfossils deposited in ocean sediments confirmed the hypothesis that variations in the Earth's orbital geometry control the ice ages, fundamental questions remain over the response of the Antarctic ice sheets to orbital cycles. Furthermore, an understanding of the behaviour of the marine-based West Antarctic ice sheet (WAIS) during the 'warmer-than-present' early-Pliocene epoch ( approximately 5-3 Myr ago) is needed to better constrain the possible range of ice-sheet behaviour in the context of future global warming. Here we present a marine glacial record from the upper 600 m of the AND-1B sediment core recovered from beneath the northwest part of the Ross ice shelf by the ANDRILL programme and demonstrate well-dated, approximately 40-kyr cyclic variations in ice-sheet extent linked to cycles in insolation influenced by changes in the Earth's axial tilt (obliquity) during the Pliocene. Our data provide direct evidence for orbitally induced oscillations in the WAIS, which periodically collapsed, resulting in a switch from grounded ice, or ice shelves, to open waters in the Ross embayment when planetary temperatures were up to approximately 3 degrees C warmer than today and atmospheric CO(2) concentration was as high as approximately 400 p.p.m.v. (refs 5, 6). The evidence is consistent with a new ice-sheet/ice-shelf model that simulates fluctuations in Antarctic ice volume of up to +7 m in equivalent sea level associated with the loss of the WAIS and up to +3 m in equivalent sea level from the East Antarctic ice sheet, in response to ocean-induced melting paced by obliquity. During interglacial times, diatomaceous sediments indicate high surface-water productivity, minimal summer sea ice and air temperatures above freezing, suggesting an additional influence of surface melt under conditions of elevated CO(2).

Sensitisation to Lepisma saccharina (silverfish) in children with respiratory allergy.

BACKGROUND: Lepisma saccharina (silverfish) is a common insect which is often found in human dwellings. Our aim was to determine the IgE antibody pattern to this arthropod in children with allergic respiratory symptoms. METHODS: The individual sera and a pool of selected sera of 45 children with asthma and/or rhinitis were used for an immunoblotting test with an extract of Lepisma saccharina; an immunoblotting inhibition test was performed with extracts of L. saccharina, D. pteronyssinus and cockroach. RESULTS: Between one and ten IgE binding bands were found in the sera of patients. The immunoblotting pattern was clearly different from that of D. pteronyssinus. Inhibition was found with D. pteronys-sinus and cockroach, which proves cross-reactivity between extracts. CONCLUSION: Allergenicity of Lepisma is demonstrated through in vitro tests. A pathogenic role still remains to be proved, but it should be considered in respiratory allergy, due to primary sensitisation to Lepisma, or to cross-reactivity with other indoor allergens.