First-Principles Identification of Single Photon Emitters Based on Carbon Clusters in Hexagonal Boron Nitride.

A recent study associates carbon with single photon emitters (SPEs) in hexagonal boron nitride (h-BN). This observation, together with the high mobility of carbon in h-BN, suggests the existence of SPEs based on carbon clusters. Here, by means of density functional theory calculations, we studied clusters of substitutional carbon atoms up to tetramers in h-BN. Two different conformations of neutral carbon trimers have zero-point line energies and shifts of the phonon sideband compatible with typical photoluminescence spectra. Moreover, some conformations of two small C clusters next to each other result in photoluminescence spectra similar to those found in the experiments. We also showed that vacancies are unable to reproduce the typical features of the phonon sideband observed in most measurements because of the large spectral weight of low-energy breathing modes, ubiquitous in such defects.

Supervivencia y estado neurológico de la parada cardiaca extrahospitalaria en edad pediátrica en Andalucía / Survival and neurological status after out-of-hospital cardiac arrest in the pediatric population in Andalusia

OBJETIVO: No existe demasiada información sobre la evolución y estado neurológico a largo plazo de los pacientes en edad pediátrica que sobreviven a una parada cardiaca extrahospitalaria. Nuestro objetivo es describir la supervivencia y estado neurológico de estos pacientes a largo plazo. DISEÑO: Estudio observacional retrospectivo. Basado en el Registro Andaluz de Parada Cardiaca Extrahospitalaria. ÁMBITO: Atención Prehospitalaria. PACIENTES: Entre 0 y 15 años atendidos entre enero de 2008 y diciembre de 2012 por Parada Cardiaca Extrahospitalaria. Intervenciones: Seguimiento de pacientes. Variables: Se incluyen variables de la atención prehospitalaria, hospitalaria y del seguimiento al año y un seguimiento específico de los supervivientes en junio de 2014. RESULTADOS: Se incluyeron en el registro un total de 5069 pacientes de los que 125(2.5%) tenían 15 o menos años. La parada fue presenciada en el 52.8% de los casos y hubo reanimación previa en 65.6%. El ritmo inicial fue desfibrilable en 7 (5.2%) casos. Un 48.8% de los pacientes llegó al hospital aunque un 20% lo hizo en situación de reanimación en curso. De los 9 (7.2%) pacientes que sobrevivieron al alta hospitalaria, 5 de ellos lo hicieron con recuperación ad integrum y 4 con grave deterioro neurológico. Los 5 pacientes con recuperación completa mantuvieron su situación a largo plazo. Los 4 pacientes restantes, aunque con discreta mejoría, se mantuvieron en situación de discapacidad neurológica. CONCLUSIONES: La supervivencia de la parada cardiaca extrahospitalaria en edad pediátrica es baja. El pronóstico a largo plazo de los pacientes con buena recuperación neurológica desde el inicio se mantiene, aunque la mejoría en el resto es mínima

OBJECTIVE: Little is known about the evolution and long-term neurological status of pediatric patients who survive out-of-hospital cardiac arrest. Our aim is to describe long-term survival and neurological status. DESIGN: Retrospective observational study, based on the Andalusian Register of out-of-hospital Cardiac Arrest. SETTING: Pre-hospital Care. PATIENTS: The study included patients aged 0-15 years between January 2008 and December 2012. Interventions: Patients follow up. Variables: Prehospital and hospital care variables were analyzed and one-year follow-up was performed, along with a specific follow-up of survivors in June 2014. RESULTS: Of 5069 patients included in the register, 125 (2.5%) were aged less or equal15 years. Cardiac arrest was witnessed in 52.8% of cases and resuscitation was performed in 65.6%. The initial rhythm was shockable in 7 (5.2%) cases. Nearly half (48.8%) the patients reached the hospital alive, of whom 20% did so while receiving resuscitation maneuvers. Only 9 (7.2%) patients survived to hospital discharge; 5 showed ad integrum recovery and 4 showed significant neurological impairment. The 5 patients with complete recovery continued their long-term situation. The remaining 4 patients, although slight improvement, were maintained in situation of neurological disability. CONCLUSIONS: Survival after out-of-hospital cardiac arrest in pediatric patients was low. The long-term prognosis of survivors with good neurological recovery remains, although improvement in the rest was minimal

Survival and neurological status after out-of-hospital cardiac arrest in the pediatric population in Andalusia.

OBJECTIVE: Little is known about the evolution and long-term neurological status of pediatric patients who survive out-of-hospital cardiac arrest. Our aim is to describe long-term survival and neurological status. DESIGN: Retrospective observational study, based on the Andalusian Register of out-of-hospital Cardiac Arrest. SETTING: Pre-hospital Care. PATIENTS: The study included patients aged 0-15 years between January 2008 and December 2012. INTERVENTIONS: Patients follow up. VARIABLES: Prehospital and hospital care variables were analyzed and one-year follow-up was performed, along with a specific follow-up of survivors in June 2014. RESULTS: Of 5069 patients included in the register, 125 (2.5%) were aged ≤15 years. Cardiac arrest was witnessed in 52.8% of cases and resuscitation was performed in 65.6%. The initial rhythm was shockable in 7 (5.2%) cases. Nearly half (48.8%) the patients reached the hospital alive, of whom 20% did so while receiving resuscitation maneuvers. Only 9 (7.2%) patients survived to hospital discharge; 5 showed ad integrum recovery and 4 showed significant neurological impairment. The 5 patients with complete recovery continued their long-term situation. The remaining 4 patients, although slight improvement, were maintained in situation of neurological disability. CONCLUSIONS: Survival after out-of-hospital cardiac arrest in pediatric patients was low. The long-term prognosis of survivors with good neurological recovery remains, although improvement in the rest was minimal.

Comentario sobre «Supervivencia y pronóstico neurológico en paradas cardiorrespiratorias extrahospitalarias por ritmos desfibrilables tratadas con hipotermia terapéutica moderada» / Comment on: "Survival and neurological outcome in out-of-hospital cardiac arrests due to shockable rhythms treated with mild therapeutic hypothermia"

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Recommendations in dispatcher-assisted bystander resuscitation from emergency call center.

Dispatch-assisted bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest has been shown as an effective measure to improve the survival of this process. The development of a unified protocol for all dispatch centers of the different emergency medical services can be a first step towards this goal in our environment. The process of developing a recommendations document and the realization of posters of dispatch-assisted cardiopulmonary resuscitation, agreed by different actors and promoted by the Spanish Resuscitation Council, is presented.

Transethnic meta-analysis suggests genetic variation in the HEME pathway influences potassium response in patients treated with hydrochlorothiazide.

Hypokalemia is a recognized adverse effect of thiazide diuretic treatment. This phenomenon, which may impair insulin secretion, has been suggested to be a reason for the adverse effects on glucose metabolism associated with thiazide diuretic treatment of hypertension. However, the mechanisms underlying thiazide diuretic-induced hypokalemia are not well understood. In an effort to identify genes or genomic regions associated with potassium response to hydrochlorothiazide, without a priori knowledge of biologic effects, we performed a genome-wide association study and a multiethnic meta-analysis in 718 European- and African-American hypertensive participants from two different pharmacogenetic studies. Single-nucleotide polymorphisms rs10845697 (Bayes factor=5.560) on chromosome 12, near to the HEME binding protein 1 gene, and rs11135740 (Bayes factor=5.258) on chromosome 8, near to the Mitoferrin-1 gene, reached genome-wide association study significance (Bayes factor >5). These results, if replicated, suggest a novel mechanism involving effects of genes in the HEME pathway influencing hydrochlorothiazide-induced renal potassium loss.

Genome-wide association analyses suggest NELL1 influences adverse metabolic response to HCTZ in African Americans.

Hydrochlorothiazide (HCTZ) is one of the most widely prescribed antihypertensive medications. Although it is well known that HCTZ is associated with hyperglycemia and hypertriglyceridemia, the mechanisms underlying these adverse effects are not well understood. We performed a genome-wide association study and meta-analysis of the change in fasting plasma glucose and triglycerides in response to HCTZ from two different clinical trials: the Pharmacogenomic Evaluation of Antihypertensive Responses and the Genetic Epidemiology of Responses to Antihypertensive studies. Two single-nucleotide polymorphisms (rs12279250 and rs4319515 (r(2)=0.73)), located at 11p15.1 in the NELL1 gene, achieved genome-wide significance for association with change in fasting plasma triglycerides in African Americans, whereby each variant allele was associated with a 28 mg dl(-1) increase in the change in triglycerides. NELL1 encodes a cytoplasmic protein that contains epidermal growth factor-like repeats and has been shown to represses adipogenic differentiation. These findings may represent a novel mechanism underlying HCTZ-induced adverse metabolic effects.

Descripción y resultados iniciales del registro andaluz de parada cardiaca extrahospitalaria / Description of cases in the Andalusian registry of out-of-hospital cardiac arrest and initial results

OBJETIVOS: La incidencia y los resultados en la parada cardiaca extrahospitalaria muestran gran variabilidad entre países o regiones. Nuestro objetivo es describir los procedimientos y resultados de un registro continuo de ámbito regional. MÉTODO: Descripción y análisis de un registro continuo de casos de parada cardiaca extrahospitalaria atendidos por un sistema de emergencias médicas (SEM). Periodo: enero- 2008/diciembre-2010. Se realiza análisis descriptivo y de los factores asociados con el alta hospitalaria con buen estado neurológico (CPC1-2). RESULTADOS: Se registraron 8.889 pacientes y se realizó reanimación en 3.054 (34,4%): 2.103 (71%) hombres y 857 (29%) mujeres. La media de edad fue 60,1 (DE 17,8) años (hombres: 59, DE = 17,8; mujeres: 63, DE = 19,4). En un tercio de las llamadas el motivo no fue inconsciencia. El 30% de las paradas no fueron presenciadas. La hora del colapso se recogió en el 83,7% de los casos. El ritmo inicial fue desfibrilable en el 19,3%. Hubo reanimación previa por testigos en el 12,8%. El 29% de los pacientes llegó con pulso al hospital, que alcanzó el 56,7% cuando el ritmo inicial era desfibrilable. El 9,1% recibieron el alta con CPC1-2. Los factores asociados con CPC1-2 al alta fueron: lugar de parada "no domicilio" (OR: 2,06; IC: 1,22-3,47), parada presenciada (OR: 2,14; IC: 1,12-4,14), ritmo inicial desfibrilable (OR: 7,04; IC: 4,31-11,5), desfibrilación previa a la llegada del equipo de emergencias (EE) (OR: 2,33; IC: 1,09-4,98) y etiología cardiaca (OR: 2,30; IC: 1,27-4,14). CONCLUSIONES: La automatización en la inclusión de pacientes favorece una alta exhaustividad y minimiza sesgos de inclusión. La fase previa a la llegada de los EE es un aspecto clave en la supervivencia con estado neurológico CPC1-2 y un área de mejora para los SEM

BACKGROUND AND OBJECTIVE: The incidence of out-of-hospital cardiac arrest and response outcomes are highly variable between countries or geographic regions. We aimed to describe procedures and outcomes in these cases based on data from a regional registry. METHODS: Description and analysis of registered cases of out-of-hospital cardiac arrest treated by an emergency response service from January 2008 to December 2010. Descriptive statistics were analyzed; we also explored factors associated with a satisfactory cerebral performance category (CPC) of 1 or 2 on discharge. RESULTS: Records were obtained for 8889 patients, of whom 3054 (34.4%) were resuscitated; 2,103 (71.04%) of the patients were men and 857 (29%) women. The mean (SD) age was 60.1 (17.8) years (men, 59 [17.8] years; women, 63 (19.4) years. In a third of the calls, the patient had not lost consciousness. In 30%, no witnesses were present at the time of cardiac arrest, and in 83.7% the time of collapse was recorded. A shockable heart rhythm was detected at the start of resuscitation in 19.3%. Witnesses had previously attempted resuscitation of 12.8%. Pulse was present on arrival at the hospital in 56.7% of the patients with a shockable heart rhythm on start of resuscitation. Discharge with a CPC1-2 was possible in 9.1%. Factors associated with a CPC1-2 were cardiac arrest outside the home (odds ratio [OR], 2.056; 95% CI, 1.218-3.472), witnessed event (OR, 2.137; 95% CI, 1.117-4.138), initial shockable heart rhythm (OR, 7.040; 95% CI, 4.313-11.490), defibrillation prior to arrival of first emergency responders (OR, 2.330; 95% CI, 1.091-4.976), and cardiac etiology (OR, 2.295; 95% CI, 1.270-4.145). CONCLUSIONS: Automatic registry of cases facilitates inclusion of all patients and minimizes bias. Factors during the period prior to the arrival of first emergency responders are key to survival in CPC1-2 status and are an aspect to target for improvement

Association of KCNJ1 variation with change in fasting glucose and new onset diabetes during HCTZ treatment.

Thiazide-induced potassium loss may contribute to new onset diabetes (NOD). KCNJ1 encodes a potassium channel and one study observed that a KCNJ1 single-nucleotide polymorphism (SNP) was associated with changes in fasting glucose (FG) during hydrochlorothiazide (HCTZ) treatment. We used linear regression to test association of KCNJ1 SNPs and haplotypes with FG changes during HCTZ treatment in the Pharmacogenomic Evaluation of Antihypertensive Responses (PEAR) study. We used logistic regression to test association of KCNJ1 variation with NOD in HCTZ-treated patients from the International Verapamil SR Trandolapril Study (INVEST). Multivariate regression analyses were performed by race/ethnicity with false discovery rate (FDR) correction. In PEAR blacks, a KCNJ1 SNP was associated with increased FG during HCTZ treatment (beta=8.47, P(FDR)=0.009). KCNJ1 SNPs and haplotypes were associated with NOD risk in all INVEST race/ethnic groups (strongest association: odds ratio 2.14 (1.31-3.53), P(FDR)=0.03). Our findings support that KCNJ1 variation is associated with HCTZ-induced dysglycemia and NOD.

Comentario al artículo original. Unidades de soporte vital básico y avanzado en España: análisis de la situación actual / S. Ballesteros / Coment on the original article. Basic and advanced life support units in Spain: analysis and current situations

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Técnicas de imagen para el estudio de la recuperación funcional tras el ictus: II. Técnicas complementarias / Imaging techniques for studying functional recovery following a stroke: II. Complementary techniques

Resumen. Muchos pacientes que sobreviven a un ictus se enfrentan a serias discapacidades funcionales durante el resto de sus vidas, lo que supone un drama personal para sí mismos y sus allegados, y un elevado coste para la sociedad. Por ello, la recuperación funcional del sujeto tras un ictus debe ser un objetivo esencial que habría que considerar en el desarrollo de nuevas aproximaciones terapéuticas. Éste es el segundo de una serie de dos trabajos en los que revisamos las estrategias y herramientas disponibles hoy en día para la evaluación de múltiples aspectos relacionados con la función cerebral (tanto en humanos como en animales de experimentación), y que están ayudando a los neurocientíficos a entender mejor los procesos de restauración y reorganización de la función cerebral que se inician tras un ictus, partiendo de la premisa de que una aproximación multidisciplinar proporciona una perspectiva más completa de los mecanismos que subyacen bajo los procesos de reparación tisular, de reorganización plástica del cerebro y de los compensatorios que se desencadenan tras un ictus. En el segundo de los trabajos de esta serie nos centramos en una serie de técnicas complementarias basadas en la imagen por resonancia magnética y que no se engloban dentro de los grupos de técnicas discutidos en el primer trabajo de esta serie, bien por abordar aspectos no relacionados directamente con la función cerebral, aunque sí lo hacen de forma indirecta, bien por estar basados en principios fisicoquímicos o fisiológicos diferentes a los ya discutidos (AU)

Summary. Many patients that survive stroke have to face serious functional disabilities for the rest of their lives, which is a personal drama for themselves and their relatives, and an elevated charge for society. Thus, functional recovery after stroke must be a key aspect of the development of new therapeutic approaches. This is the second of a series of two works on which we review the strategies and tools available nowadays for the assessment of multiple aspects related to brain function (both in humans and research animals) and that are helping neuroscientist to better understand the processes of functional restoration and reorganization of the brain, that are triggered following stroke. We have assumed that a multidisciplinary approach is able to provide us with a wider perspective of the underlying mechanisms behind tissue repair, plastic reorganization of the brain and compensatory mechanisms, that can be triggered after stroke. In the second of the works of this series we are focusing in a series of techniques, complementary to the already discussed in the first work, and that are based on MR. These techniques are discussed separately from those ones, because they tackle with aspects not directly related to brain function, although they somehow do in indirect ways, or because they are based on physicochemical or physiological principles different from those discussed on the first work of this series (AU)

Actividad de los equipos de emergencias extrahospitalarios / Activity of the out of hospital emergency teams

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[Appropriateness admissions to the Department of Internal Medicine of the Hospital de Santa Luzia (Elvas) evaluated by the AEP (Appropriateness Evaluation Protocol)]. / Adequação dos internamentos num Serviço de Medicina. Aplicação da escala AEP (Appropriateness Evaluation Protocol).

The authors analyse the appropriateness admissions to the Internal Medicine ward of the Hospital de Santa Luzia (Elvas). A retrospective study was performed during 6 months of 2001, using the Appropriateness Evaluation Protocol (AEP). Non-appropriateness admissions were found in 19% (CI95%: 16-22), and this group of patients had less mean age (63 + 16 vs 69 + 16; p <0.01), and less mean days of admission (7.1 + 6 vs 9.3 + 7; p <0.01) than group with appropriateness admissions. Appropriateness admissions were mainly found in patients admitted from the emergency room (86% vs 49%; p <0.001). Most of patients with non-appropriate admissions were admitted to undergo diagnostic tests (44%; CI95%: 35-53), or to be referred to other medical centres for specialized study and/or treatment (12%; CI95%: 6-18).

[Assessment of the nutritional status of elderly patients treated at a home-hospital unit]. / Evaluación del estado nutricional de los pacientes mayores atendidos en una unidad de hospitalización a domicilio.

GOALS: To establish the nutritional status of our elderly patients, assess the usefulness of the various anthropometric and biochemical parameters as markers of malnutrition and to determine which of the variables studied have the greatest correlation with malnutrition. SCOPE: Home Hospital Unit of the Arnau de Vilanova Teaching Hospital in Lerida. PATIENTS: 57 patients > or = 60 years. Mean admission to our unit: 12.1 days. VARIABLES: Age, sex, groups by treatment complexity, associated pathology, diagnosis, reason for admission, duration of stay in hospital, surgery performed, complications during the stay at the Home Hospital Unit, weight, height, PCT, AC, BMI, albumin, haemoglobin and RTL. RESULTS: Patients of great age present lower levels of serum albumin (p < 0.005), total proteins (p < 0.001), transferrin (p < 0.03), haemoglobin (p < 0.02) and RTL (p < 0.04) than "younger" elderly patients. Serum albumin and haemoglobin are lower in patients in a complicated post-surgical condition (p < 0.04 and p < 0.02, respectively) and this group is the one with the longest stays (p < 0.001). Those patients with hypoalbuminaemia (74.1%) present lower PCT and RTL (p < 0.02) and a longer stay in hospital (p < 0.01) than those with normal levels of albumin in blood. Patients with anaemia (63.3%) present a lower RTL (p < 0.01) and a greater hospitalization time than those without anaemia. Total proteins (p < 0.0001), albumin (p < 0.004), transferrin (p < 0.003) and RTL (p < 0.005) correlate negatively with age. Albumin (p < 0.001), haemoglobin (p < 0.006) and RTL (p < 0.0001) present a negative correlation with length of hospital stay. CONCLUSION: The prevalence of global malnutrition is high (51% moderate-severe). The nutritional status worsens with age. The length of hospitalization increases gradually with age, with deteriation in the nutritional status and with complexity of the treatment provided.

Leptospirosis en niños de la provincia de Ciego de Ávila, en 20 años de observación / Leptospirosis in children from the province of Ciego de Avila; 20 years of observation

Se analizaron 275 casos reportados en edades pediátricas en el período de 1980 al 2000 en la provincia Ciego de Ávila. Predominó el grupo de 10 a 14 años, seguido de 5 a 9 años. Fue más frecuente el sexo masculino. Sólo se reportó un fallecido. Los síntomas y signos de mayor frecuencia fueron fiebre, cefalea y mialgia. El 92 por ciento de los casos eran anictéricos. Los diagnósticos presuntivos más planteados fueron leptospirosis, síndrome febril agudo y meningoencefalitis viral. En las posibles fuentes de infección el baño en fuentes de agua dulce y el contacto con terrenos bajos presentaron el mayor número de casos. Se analizaron en el estudio ciertas diferencias con el cuadro clínico de los adultos y se señala que a medida que se ha ido investigando esta entidad en pediatría el reporte es mayor (AU)

Sistema integral de urgencias: funcionamiento de los equipos de emergencias en España / Emergency care integral system: working of the out-of hospital emergency teams in Spain

Hoy día, la asistencia a las urgencias sanitarias se entiende dentro del concepto de sistema integral de urgencias, el cual unifica los diferentes niveles asistenciales implicados en la resolución de éstas, en un único proceso asistencial. Uno de los últimos eslabones incorporados a esta cadena han sido los equipos de emergencias (EE) extrahospitalarios, implantados en la actualidad en casi toda la geografía española. Estos EE, por sus peculiaridades en cuanto a su composición, funcionamiento y en torno de trabajo, tienen una entidad propia dentro de la cadena asistencial de las urgencias y emergencias sanitarias (AU)

[Leptospirosis in children in Ciego de Avila Province, Cuba]. / Leptospirosis en niños de la Provincia de Ciego de Avila, Cuba.

The morbidity of leptospirosis among children from Ciego de Avila Province was investigated from 1982 to 1995, and 253 cases were diagnosed. Isolated cases prevailed over those occurring in outbreaks. The 10-14 age group was predominant, followed by the 5-9 age group. According to sex, it was more frequently found in males than in females. One death occurred during this period. There was an increase of cases from July to August and October, and November showed a higher incidence of cases. Fever, headache and myalgia were the symptoms and signs more frequently reported, and 92% of cases showed no icterus. Acute fever, leptospirosis and viral meningoencephalitis were the presumptive diagnoses most frequently made. Possible sources of infection involving a larger number of cases were contact with low terrains and bathing in rivers, ponds and lakes. Regarding diagnosis, 162 cases were diagnosed by the microagglutination test and 91 by the hemolytic test. Canicola, australis and pomona were the serogroups more frequently detected by the microagglutination test.