Chloride reduces plant nitrate requirement and alleviates low nitrogen stress symptoms.

Chloride (Cl-) is traditionally categorized as an antagonist of nitrate (NO3-) because Cl- hinders plant NO3- transport and accumulation. However, we have recently defined Cl- as a beneficial macronutrient for higher plants, due to specific functions that lead to more efficient use of water, nitrogen (N) and CO2 under optimal N and water supply. When accumulated in leaves at macronutrient levels, Cl- promotes growth through osmotic, physiological, metabolic, anatomical and cellular changes that improve plant performance under optimal NO3- nutrition. Nitrate over-fertilization in agriculture can adversely affect crop yield and nature, while its deficiency limits plant growth. To study the relationship between Cl- nutrition and NO3- availability, we have characterized different physiological responses such as growth and yield, N-use efficiency, water status, photosynthesis, leaf anatomy, pigments and antioxidants in tomato plants treated with or without 5 mM Cl- salts and increasing NO3- treatments (3-15 mM). First, we have demonstrated that 5 mM Cl- application can reduce the use of NO3- in the nutrient solution by up to half without detriment to plant growth and yield in tomato and other horticultural plants. Second, Cl- application reduced stress symptoms and improved plant growth under low-NO3- conditions. The Cl--dependent resistance to low-N stress resulted from: more efficient use of the available NO3-; improved plant osmotic and water status regulation; improved stomatal conductance and photosynthetic rate; and better antioxidant response. We proposed that beneficial Cl- levels increase the crop ability to grow better with lower NO3- requirements and withstand N deficiency, promoting a more sustainable and resilient agriculture.

Analysis of the Mechanical Properties of a Stabilized Subgrade Type Soil under a Sustainable Approach for Construction.

This article presents an experimental study to analyze the mechanical properties of a soil stabilized with ordinary Portland cement (OPC) under a sustainable approach consisting of a significant substitution of OPC for sugarcane bagasse ash (SCBA) to reduce the quantity of cement used in the stabilization, reaching the necessary mechanical requirements for its use as a subgrade layer. Soil specimens were elaborated with 3%, 5%, and 7% OPC as a stabilizing agent by weight of the soil. These mixtures were then partially substituted with 25%, 50%, and 75% SCBA, with these percentages being by weight of the stabilizer (OPC). Compaction, compressive strength, and California bearing ratio (CBR) tests were performed to evaluate the mechanical properties of the specimens. The results indicate that a 25% substitution of OPC by SCBA shows a similar performance to the mixture with only Portland cement, so a reduction in OPC use can be made. Further, with a substitution of 100% OPC by SCBA, the CBR of natural soil without stabilizers is improved.

Nitrogen assimilation and photorespiration become more efficient under chloride nutrition as a beneficial macronutrient.

Chloride (Cl-) and nitrate ( NO 3 - ) are closely related anions involved in plant growth. Their similar physical and chemical properties make them to interact in cellular processes like electrical balance and osmoregulation. Since both anions share transport mechanisms, Cl- has been considered to antagonize NO 3 - uptake and accumulation in plants. However, we have recently demonstrated that Cl- provided at beneficial macronutrient levels improves nitrogen (N) use efficiency (NUE). Biochemical mechanisms by which beneficial Cl- nutrition improves NUE in plants are poorly understood. First, we determined that Cl- nutrition at beneficial macronutrient levels did not impair the NO 3 - uptake efficiency, maintaining similar NO 3 - content in the root and in the xylem sap. Second, leaf NO 3 - content was significantly reduced by the treatment of 6 mM Cl- in parallel with an increase in NO 3 - utilization and NUE. To verify whether Cl- nutrition reduces leaf NO 3 - accumulation by inducing its assimilation, we analysed the content of N forms and the activity of different enzymes and genes involved in N metabolism. Chloride supply increased transcript accumulation and activity of most enzymes involved in NO 3 - assimilation into amino acids, along with a greater accumulation of organic N (mostly proteins). A reduced glycine/serine ratio and a greater ammonium accumulation pointed to a higher activity of the photorespiration pathway in leaves of Cl--treated plants. Chloride, in turn, promoted higher transcript levels of genes encoding enzymes of the photorespiration pathway. Accordingly, microscopy observations suggested strong interactions between different cellular organelles involved in photorespiration. Therefore, in this work we demonstrate for the first time that the greater NO 3 - utilization and NUE induced by beneficial Cl- nutrition is mainly due to the stimulation of NO 3 - assimilation and photorespiration, possibly favouring the production of ammonia, reductants and intermediates that optimize C-N re-utilization and plant growth. This work demonstrates new Cl- functions and remarks on its relevance as a potential tool to manipulate NUE in plants.

A conserved C-terminal peptide of sorghum phosphoenolpyruvate carboxylase promotes its proteolysis, which is prevented by Glc-6P or the phosphorylation state of the enzyme.

MAIN CONCLUSION: A synthetic peptide from the C-terminal end of C4-phosphoenolpyruvate carboxylase is implicated in the proteolysis of the enzyme, and Glc-6P or phosphorylation of the enzyme modulate this effect. Phosphoenolpyruvate carboxylase (PEPC) is a cytosolic, homotetrameric enzyme that performs a variety of functions in plants. Among them, it is primarily responsible for CO2 fixation in the C4 photosynthesis pathway (C4-PEPC). Here we show that proteolysis of C4-PEPC by cathepsin proteases present in a semi-purified PEPC fraction was enhanced by the presence of a synthetic peptide containing the last 19 amino acids from the C-terminal end of the PEPC subunit (pC19). Threonine (Thr)944 and Thr948 in the peptide are important requirements for the pC19 effect. C4-PEPC proteolysis in the presence of pC19 was prevented by the PEPC allosteric effector glucose 6-phosphate (Glc-6P) and by phosphorylation of the enzyme. The role of these elements in the regulation of PEPC proteolysis is discussed in relation to the physiological context.

From physiology to salt marsh management challenges with sea level rise: the case of native Spartina foliosa, invasive S. densiflora and their hybrid.

Sea level rise (SLR) imposes increasing salinity and inundation stresses in salt marshes which simultaneously face invasions by exotic plant species. We aimed to improve and apply knowledge on the ecophysiological responses of halophytes to SLR to conservation management of salt marshes. In a mesocosm experiment, we measured and compared phosphoenolpyruvate carboxylase (PEPC) activity and related functional traits of the California-native Spartina foliosa, invasive S. densiflora and their hybrid S. densiflora × foliosa in response to increasing levels of salinity and inundation. S. foliosa was moderately sensitive to salinity, showing a 57% reduction in PEPC specific activity from freshwater to hypersalinity. This native species compensated for the reduction of PEPC activity with increased salinity through 80% higher enzyme activation by phosphorylation. PEPC functional trait responses of S. foliosa were mostly independent of inundation depth. In view of these results, managers should conserve undeveloped lands for accommodation space above current high tide lines to facilitate colonization of stress-tolerant S. foliosa. Our results on functional responses of PEPC traits recorded high sensitivity to salinity for S. densiflora. This was reflected by 65% lower PEPC specific activity together with increasing accumulation of free proline (+96%) and total proteins (+23%) with elevated salinity. These results suggest prioritized eradication of S. densiflora populations in brackish habitats. Measured PEPC responses support the high stress tolerance of the S. densiflora × foliosa hybrid. PEPC traits for the hybrid were mostly independent of salinity and inundation. The hybrid showed higher PEPC-specific activity than S. foliosa (+70%) and S. densiflora (+15%) in freshwater under intermediate inundation. Results suggest that eradication of the hybrid should be the highest management priority. Our study shows that the responses of key functional physiological traits to environmental stresses serve as biological indicators that can guide ecosystem management practices in a scenario of climate change.

Chloride Improves Nitrate Utilization and NUE in Plants.

Chloride (Cl-) has traditionally been considered harmful to agriculture because of its toxic effects in saline soils and its antagonistic interaction with nitrate (NO3 -), which impairs NO3 - nutrition. It has been largely believed that Cl- antagonizes NO3 - uptake and accumulation in higher plants, reducing crop yield. However, we have recently uncovered that Cl- has new beneficial macronutrient, functions that improve plant growth, tissue water balance, plant water relations, photosynthetic performance, and water-use efficiency. The increased plant biomass indicates in turn that Cl- may also improve nitrogen use efficiency (NUE). Considering that N availability is a bottleneck for the plant growth, the excessive NO3 - fertilization frequently used in agriculture becomes a major environmental concern worldwide, causing excessive leaf NO3 - accumulation in crops like vegetables and, consequently, a potential risk to human health. New farming practices aimed to enhance plant NUE by reducing NO3 - fertilization should promote a healthier and more sustainable agriculture. Given the strong interaction between Cl- and NO3 - homeostasis in plants, we have verified if indeed Cl- affects NO3 - accumulation and NUE in plants. For the first time to our knowledge, we provide a direct demonstration which shows that Cl-, contrary to impairing of NO3 - nutrition, facilitates NO3 - utilization and improves NUE in plants. This is largely due to Cl- improvement of the N-NO3 - utilization efficiency (NUTE), having little or moderate effect on N-NO3 - uptake efficiency (NUPE) when NO3 - is used as the sole N source. Clear positive correlations between leaf Cl- content vs. NUE/NUTE or plant growth have been established at both intra- and interspecies levels. Optimal NO3 - vs. Cl- ratios become a useful tool to increase crop yield and quality, agricultural sustainability and reducing the negative ecological impact of NO3 - on the environment and on human health.

Changes to the functional traits of phosphoenolpyruvate carboxylase following hybridization in C-4 halophytes.

Hybridization is a relevant evolutionary mechanism linked to the invasiveness of plant species, but little is known about its effect on enzymatic activities in response to stress. We analyzed the effects of salinity on key mechanistic traits of phosphoenolpyruvate carboxylase (PEPC) enzyme for two hybrid taxa derived from native Spartina maritima (Curtis) Fernald and invasive Spartina densiflora Brongn. in comparison with their parental species. Parental species showed contrasted strategies at the PEPC level to cope with salinity. Spartina maritima showed its physiological optimum at 10 to 40 ppt salinity, with high PEPC activity (per unit leaf soluble protein), in contrast to the lower salinity optimum of 0.5 and 10 ppt for S. densiflora, where highest levels of PEPC apparent specific activity coincided with high light-induced activation of PEPC. Both hybrids showed constant PEPC apparent specific activity from fresh water to hypersalinity and exhibited higher net photosynthesis rates in fresh water than their parents. Spartina maritima × densiflora presented three transgressive PEPC-related traits, being the only taxon able to increase its PEPC activation in darkness at high salinity. Spartina densiflora × maritima showed most PEPC-related traits intermediate between its parents. Inheritance types operating differently in reciprocal hybrids determine key functional traits conditioning their ecological performance.

Chloride as a macronutrient increases water-use efficiency by anatomically driven reduced stomatal conductance and increased mesophyll diffusion to CO2.

Chloride (Cl- ) has been recently described as a beneficial macronutrient, playing specific roles in promoting plant growth and water-use efficiency (WUE). However, it is still unclear how Cl- could be beneficial, especially in comparison with nitrate (NO3- ), an essential source of nitrogen that shares with Cl- similar physical and osmotic properties, as well as common transport mechanisms. In tobacco plants, macronutrient levels of Cl- specifically reduce stomatal conductance (gs ) without a concomitant reduction in the net photosynthesis rate (AN ). As stomata-mediated water loss through transpiration is inherent in the need of C3 plants to capture CO2 , simultaneous increase in photosynthesis and WUE is of great relevance to achieve a sustainable increase in C3 crop productivity. Our results showed that Cl- -mediated stimulation of larger leaf cells leads to a reduction in stomatal density, which in turn reduces gs and water consumption. Conversely, Cl- improves mesophyll diffusion conductance to CO2 (gm ) and photosynthetic performance due to a higher surface area of chloroplasts exposed to the intercellular airspace of mesophyll cells, possibly as a consequence of the stimulation of chloroplast biogenesis. A key finding of this study is the simultaneous improvement of AN and WUE due to macronutrient Cl- nutrition. This work identifies relevant and specific functions in which Cl- participates as a beneficial macronutrient for higher plants, uncovering a sustainable approach to improve crop yield.

Anionic Phospholipids Induce Conformational Changes in Phosphoenolpyruvate Carboxylase to Increase Sensitivity to Cathepsin Proteases.

Phosphoenolpyruvate carboxylase (PEPC) is a cytosolic, homotetrameric enzyme that serves a variety of functions in plants, acting as the primary form of CO2 fixation in the C4 photosynthesis pathway (C4-PEPC). In a previous work we have shown that C4-PEPC bind anionic phospholipids, resulting in PEPC inactivation. Also, we showed that PEPC can associate with membranes and to be partially proteolyzed. However, the mechanism controlling this remains unknown. Using semi purified-PEPC from sorghum leaf and a panel of PEPC-specific antibodies, we analyzed the conformational changes in PEPC induced by anionic phospholipids to cause the inactivation of the enzyme. Conformational changes observed involved the exposure of the C-terminus of PEPC from the native, active enzyme conformation. Investigation of the protease activity associated with PEPC demonstrated that cysteine proteases co-purify with the enzyme, with protease-specific substrates revealing cathepsin B and L as the major protease species present. The anionic phospholipid-induced C-terminal exposed conformation of PEPC appeared highly sensitive to the identified cathepsin protease activity and showed initial proteolysis of the enzyme beginning at the N-terminus. Taken together, these data provide the first evidence that anionic phospholipids promote not only the inactivation of the PEPC enzyme, but also its proteolysis.

Estudio Transversal: Correlación entre la Puntuación del Calcio y la Tomografía Multidetector Coronaria / Cross-Sectional Research: Correlation between Calcium Score and Coronary Multidetector Tomography

INTRODUCCIÓN: El desarrollo tecnológico con los equipos de Tomografía Multidetector permite evaluar la formación de placas de calcio en las arterias coronarias, categorizarlas y relacionarlas con los factores de riesgo. El objetivo fue determinar la asociación de la puntuación de calcio con la hipertensión arterial, sobrepeso y obesidad, dislipidemia (colesterol total, LDL, HDL), diabetes mellitus tipo 2 y tabaquismo. MÉTODOS: Se trata de un estudio transversal con 67 pacientes a quienes se realizó el examen la puntuación de calcio con Tomografía Multidetector de 64 cortes y sincronización de la frecuencia cardíaca 60 ± 5 latidos por minuto, en el Departamento de Imagenología del Hospital de Especialidades José Carrasco Arteaga, entre Marzo - Agosto de 2016. Se aplicó una encuesta adaptada para este estudio y con el consentimiento informado. Los datos fueron analizados con el Software SPSS versión 20, la cuantificación del calcio fue de 0 negativo y > 0 positivo. RESULTADOS: La mediana de edad fue 62 años, el 55.2 % fueron hombres, el 50.7 % estaban entre 45 a 64 años, se identificó a 9 pacientes con hipertensión arterial (13.4 %), 35 pacientes tenían sobrepeso (52.2 %) y 41 pacientes con triglicéridos elevados (61.2 %). Se determinó asociación entre la variable "presión arterial sistólica en mmHg ≥ 140" RP 1.76 (IC 95 %: 1.01 ­ 3.08 P: 0.036); el resto de variables no fueron significativas. CONCLUSIONES: La puntuación de calcio positivo está asociada a la presión arterial sistólica ≥ 140 mmHgtudio Transversal: Correlación entre la Puntuación del Calcio y la Tomografía Multidetector Coronaria

BACKGROUND: The technological development with the Multidetector Tomography Equipment allows evaluating the formation of calcium plaques in the coronary arteries, categorizing them and relating them to the risk factors. The aim was to determine the calcium score with hypertension, overweight and obesity, dyslipidemia (total cholesterol, LDL, HDL), type 2 diabetes mellitus and smoking. METHODS: It is a cross-sectional study with 67 patients who underwent the examination of the calcium score with 64-slice Multidetector Tomography with synchronization of the heart rate 60 ± 5 beats per minute, in the Department of Imaging of the José Carrasco Arteaga Specialties Hospital between March - August, 2016. A survey adapted for this study and with informed consent was applied. The data were analyzed with SPSS Software version 20, the calcium quantification was 0 negative and > 0 positive. RESULTS: The median age was 62 years, 55.2 % were men, 50.7 % between 45 and 64 years, 9 patients with hypertension (13.4 %), 35 overweight patients (52.2 %) and 41 patients with high triglycerides (61.2 %). An association was determined between the variable "systolic blood pressure in mmHg ≥ 140" RP 1.76 (95 % CI: 1.01 - 3.08 P: 0.036); the rest of the variables were not significant. CONCLUSIONS: The positive calcium score is associated with systolic blood pressure ≥ 140 mmHg.

An Autonomous Underwater Recorder Based on a Single Board Computer.

As industrial activities continue to grow on the Brazilian coast, underwater sound measurements are becoming of great scientific importance as they are essential to evaluate the impact of these activities on local ecosystems. In this context, the use of commercial underwater recorders is not always the most feasible alternative, due to their high cost and lack of flexibility. Design and construction of more affordable alternatives from scratch can become complex because it requires profound knowledge in areas such as electronics and low-level programming. With the aim of providing a solution; a well succeeded model of a highly flexible, low-cost alternative to commercial recorders was built based on a Raspberry Pi single board computer. A properly working prototype was assembled and it demonstrated adequate performance levels in all tested situations. The prototype was equipped with a power management module which was thoroughly evaluated. It is estimated that it will allow for great battery savings on long-term scheduled recordings. The underwater recording device was successfully deployed at selected locations along the Brazilian coast, where it adequately recorded animal and manmade acoustic events, among others. Although power consumption may not be as efficient as that of commercial and/or micro-processed solutions, the advantage offered by the proposed device is its high customizability, lower development time and inherently, its cost.

Hidatidosis cervical primaria. A propósito de un caso / Primary hydatid cyst of the neck: Case report

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A consistent decomposition of the redistributive, vertical, and horizontal effects of health care finance by factor components.

In studies on the redistributive, vertical, and horizontal effects of health care financing, the sum of the contributions calculated for each financial instrument does not equal the total effects. As a consequence, the final calculations tend to be overestimated or underestimated. The solution proposed here involves the adaptation of the Shapley value to achieve additive results for all the effects and reveals the relative contributions of different instruments to the change of whole-system equity. An understanding of this change would help policy makers attain equitable health care financing. We test the method with the public finance and private payments of health care systems in Denmark and the Netherlands.

Factores asociados al ingreso hospitalario y evaluación de un programa de gestión de casos para trastorno mental grave mediante un estudio de cohortes históricas / Factors associated with hospital admission and evaluation of a case management program for severe mental disorder by a historical cohort study

Introducción: Las personas con trastorno mental grave (TMG) presentan serias dificultades para desarrollar una vida normalizada, por lo que son necesarios programas de atención comunitaria que mejoren sus condiciones de vida e integración social. Este trabajo pretende evaluar el funcionamiento de un programa de gestión de casos (PGC) en Segovia (España). Metodología: Se realiza una primera fase descriptiva valorando el funcionamiento del PGC en 2011 mediante variables sociodemográficas, asistenciales y clínicas. Se estudian los factores asociados a la ocurrencia de ingreso hospitalario. Finalmente, mediante un diseño de cohortes históricas, se evalúa el riesgo de ingreso del PGC comparando con una cohorte no expuesta. Se emplean técnicas estadísticas bi y multivariantes con cálculo de riesgos relativos e intervalos de confianza. Resultados: En 2011 se atiende a 82 pacientes en el PGC, principalmente hombres de mediana edad. La evolución clínica media es de 19 años y la permanencia media en el PGC superior a los 6 años. El 78% pertenecen al espectro diagnóstico de la esquizofrenia. El ingreso afecta al 27% de los pacientes. Ser mujer, ser atendido por equipos de salud mental I-II, el aumento de visitas domiciliarias y el abandono del seguimiento son los factores predictores de ingreso, mientras la mayor evolución clínica es factor protector. No se detecta efecto protector del PGC frente al ingreso hospitalario en los diferentes análisis del estudio de cohortes históricas. Conclusiones: Es necesario evaluar de forma sistemática los programas de atención comunitaria dirigidos al TMG con el fin de realizar ajustes y modificaciones tendentes a la mejora de su efectividad clínica (AU)

Introduction: People with severe mental disorder (SMD) have serious difficulties in developing a normal life, so community care programs to improve their living conditions and social integration are necessary. This work evaluates the performance of a case management program (CMP) in Segovia (Spain).Methodology: We conduct a first descriptive phase evaluating the performance of the CMP in 2011 by sociodemographic, health services and clinical variables. We study the factors associated with the occurrence of hospital admission. Finally, using a historical cohort design, we assess the risk of hospital admission of CMP compared to unexposed cohort. Bi and multivariate statistical techniques are employed to perform the analysis with the calculation of relative risks and confidence intervals. Results: In 2011, 82 patients are cared for in the CMP, mainly middle-aged men. The average clinical course is 19 years and the average stay in the CMP over 6 years. 78%belong to the diagnosis of schizophrenia spectrum. Income affects 27% of patients. Women, mental health teams I-II, increased home visits and abandonment of monitoring are predictors of income, while the highest level of clinical course is protective. No protective effect of income is detected for the CMP in the different analyzes of the historical cohort study. Conclusions: It is necessary to systematically assess community care programs directed at SMD to make adjustments and modifications aiming at improving their clinical effectiveness (AU)

[Factors associated with hospital admission and evaluation of a case management program for severe mental disorder by a historical cohort study]. / Factores asociados al ingreso hospitalario y evaluación de un programa de gestión de casos para trastorno mental grave mediante un estudio de cohortes históricas.

INTRODUCTION: People with severe mental disorder (SMD) have serious difficulties in developing a normal life, so community care programs to improve their living conditions and social integration are necessary. This work evaluates the performance of a case management program (CMP) in Segovia (Spain). METHODOLOGY: We conduct a first descriptive phase evaluating the performance of the CMP in 2011 by sociodemographic, health services and clinical variables. We study the factors associated with the occurrence of hospital admission. Finally, using a historical cohort design, we assess the risk of hospital admission of CMP compared to unexposed cohort. Bi and multivariate statistical techniques are employed to perform the analysis with the calculation of relative risks and confidence intervals. RESULTS: In 2011, 82 patients are cared for in the CMP, mainly middle-aged men. The average clinical course is 19 years and the average stay in the CMP over 6 years. 78% belong to the diagnosis of schizophrenia spectrum. Income affects 27% of patients. Women, mental health teams I-II, increased home visits and abandonment of monitoring are predictors of income, while the highest level of clinical course is protective. No protective effect of income is detected for the CMP in the different analyzes of the historical cohort study. CONCLUSIONS: It is necessary to systematically assess community care programs directed at SMD to make adjustments and modifications aiming at improving their clinical effectiveness.

El automanejo de enfermedades crónicas: población de una jurisdicción de centros de salud / The self-management of the chronic diseases: population of a jurisdiction of health centers

Objetivo: describir el automanejo en personas con enfermedades crónicas (diabetes, hipertensión y cáncer). Métodos: el estudio se realizó en poblaciones que pertenec¡an a la jurisdicción de centros de salud del Ministerio de salud, se realizó una muestra por conveniencias con el siguiente criterio de inclusón: mayores de 18 años y más de tres meses de presentar la enfermedad. Se aplicó el instrumento: ®Automanejo en padecimientos crónicos. Partners in Health Scale¯ a un total de 382 personas. Resultados: el automanejo es deficiente, con una media general de 66, para diabetes, hipertensión y cáncer. Se encontró diferencias en el automanejo en la dimensión de adherencia as¡ como de manejo de signos y s¡ntomas. Las personas con diabetes presentaron mejor automanejo en el manejo de signos y s¡ntomas frente a las personas con hipertensión y cáncer, mientras que las personas con cáncer presentaron mejor automanejo en adherencia comparadas con las personas con hipertensión y diabetes. Se encontró diferencias en el automanejo según sexo. Conclusiones: el automanejo en personas con enfermedades crónicas es deficiente en todas sus dimensiones: conocimiento, adherencia, y manejo de signos y s¡ntomas. Se requiere realizar mayores investigaciones con perspectiva de género.

Objective: To discover the self-management in people with chronic diseases (diabetes, hypertension and cancer). Methods: The research took place in population that belonged to the jurisdiction of health centers of the Ministry of Health, making a simple of conveniences with the following inclusion criteria: people over 18 years old, more than three months of having the disease. The instrument used was: ®self-management of chronic suffering. Partners in Health Scale¯. A total of 382 people. Results: The self-management is deficient, with a general average of 66, for diabetes, hypertension and cancer. Differences were found in the self-management of the adherence dimension and the management of signs and symptoms. People with diabetes had better self-management in comparison with the people with hypertension and cancer; and people with cancer had better self-management in comparison with people with hypertension and diabetes. Differences were found in the self-management according to gender. Conclusions. The self-management in people with chronic diseases is deficient, in all its dimensions: knowledge, adherence and management of signs and symptoms. More researches with gender perspective are needed.

Effectiveness of a cognitive behavioral intervention in patients with medically unexplained symptoms: cluster randomized trial.

BACKGROUND: Medically unexplained symptoms are an important mental health problem in primary care and generate a high cost in health services.Cognitive behavioral therapy and psychodynamic therapy have proven effective in these patients. However, there are few studies on the effectiveness of psychosocial interventions by primary health care. The project aims to determine whether a cognitive-behavioral group intervention in patients with medically unexplained symptoms, is more effective than routine clinical practice to improve the quality of life measured by the SF-12 questionary at 12 month. METHODS/DESIGN: This study involves a community based cluster randomized trial in primary healthcare centres in Madrid (Spain). The number of patients required is 242 (121 in each arm), all between 18 and 65 of age with medically unexplained symptoms that had seeked medical attention in primary care at least 10 times during the previous year. The main outcome variable is the quality of life measured by the SF-12 questionnaire on Mental Healthcare. Secondary outcome variables include number of consultations, number of drug (prescriptions) and number of days of sick leave together with other prognosis and descriptive variables. Main effectiveness will be analyzed by comparing the percentage of patients that improve at least 4 points on the SF-12 questionnaire between intervention and control groups at 12 months. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. DISCUSSION: This study aims to provide more insight to address medically unexplained symptoms, highly prevalent in primary care, from a quantitative methodology. It involves intervention group conducted by previously trained nursing staff to diminish the progression to the chronicity of the symptoms, improve quality of life, and reduce frequency of medical consultations. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov, number NCT01484223 [http://ClinicalTrials.gov].

Synergic effect of salinity and CO2 enrichment on growth and photosynthetic responses of the invasive cordgrass Spartina densiflora.

Spartina densiflora is a C(4) halophytic species that has proved to have a high invasive potential which derives from its clonal growth and its physiological plasticity to environmental factors, such as salinity. A greenhouse experiment was designed to investigate the synergic effect of 380 and 700 ppm CO(2) at 0, 171, and 510 mM NaCl on the growth and the photosynthetic apparatus of S. densiflora by measuring chlorophyll fluorescence parameters, gas exchange and photosynthetic pigment concentrations. PEPC activity and total ash, sodium, potassium, calcium, magnesium, and zinc concentrations were determined, as well as the C/N ratio. Elevated CO(2) stimulated growth of S. densiflora at 0 and 171 mM NaCl external salinity after 90 d of treatment. This growth enhancement was associated with a greater leaf area and improved leaf water relations rather than with variations in net photosynthetic rate (A). Despite the fact that stomatal conductance decreased in response to 700 ppm CO(2) after 30 d of treatment, A was not affected. This response of A to elevated CO(2) concentration might be explained by an enhanced PEPC carboxylation capacity. On the whole, plant nutrient concentrations declined under elevated CO(2), which can be ascribed to the dilution effect caused by an increase in biomass and the higher water content found at 700 ppm CO(2). Finally, CO(2) and salinity had a marked overall effect on the photochemical (PSII) apparatus and the synthesis of photosynthetic pigments.

Esclerosis peritoneal: análisis de dos casos / No disponible

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