Competition of electrogens with methanogens for hydrogen in bioanodes.

Bioelectrochemical systems (BES) can provide an energy efficient way to recover nutrients from wastewaters. However, the electron donors available in wastewater are often not sufficient to recover the total amount of nutrients. This work investigates hydrogen (H2) as an additional substrate for bioanodes. This hydrogen can be produced in the fermentation of complex organic waste or could be recycled from the cathode. Understanding how to influence the competition of electroactive microorganisms (EAM) with methanogens for H2 gas from different sources is key to successful application of H2 as additional electron donor in bioelectrochemical nutrient recovery. Ethanol (EtOH) was used as model compound for complex wastewaters since it is fermented into both acetate and H2. EtOH was efficiently converted into electricity (e-) by a syntrophic biofilm. Total recovered charge from 1 mM EtOH was 20% higher than for the same amount of acetate. This means that H2 from EtOH fermentation was converted by EAM into electricity. Low EtOH concentrations (1  mM) led to higher conversion efficiencies into electricity than higher concentrations (5 and 10  mM). Thermodynamic calculations show this correlates with a higher energy gain for electrogens compared to methanogens at low H2 concentrations. Cumulatively adding 1 mM EtOH without medium exchange (14 times in 14 days) resulted in stable conversion of H2 to e- (67%-77% e-) rather than methane. With H2 gas as electron donor, 68 ±â€¯2% H2 was converted into e- with no carbon source added, and still 53 ±â€¯5% to e- when 50  mM bicarbonate was provided. These results show that under the provided conditions, electrogens can outcompete methanogens for H2 as additional electron donor in MECs for nutrient recovery.

[Analysis of our experience in the diagnosis and treatment of obturator hernia in a third level hospital]. / Análisis de nuestra experiencia en el diagnóstico y tratamiento de la hernia obturatriz en un hospital de tercer nivel.

Hernia pathology accounts for a large percentage of urgent surgical interventions. Obturator hernia is rare, usually presenting as a picture of acute intestinal occlusion. The aim of the study is to analyze the experience in a third level hospital in the diagnosis and treatment of obturator hernia, as well as to detect those signs that allow an early diagnosis. This is a prospective observational study, which included patients operated on urgently for obturator hernia between 2000 and 2016. For the registration of postoperative morbidity, the Clavien-Dindo classification was used. We identified twelve patients with intestinal obstruction secondary to obturator hernia. All of them were operated on urgently. Urgent midline laparotomy was carried out on 59% of them, infraumbilical laparotomy on 33%, and a posterior inguinal approach was realized on only one patient (8%). In eight patients (67%) it was necessary to perform intestinal resection. Repair was performed by polypropylene mesh in six patients (50%), by plugging in two (17%) and closing with loose stitches in four patients (33%). Four of them presented postoperative complications, recording a single exitus secondary to perforation due to intestinal suffering. Obturator hernia is a rare entity that develops mostly as an occlusive condition in elderly women. The imaging technique of choice for diagnosis is computed tomography. Establishing an early diagnosis and urgent surgical treatment is a priority to reduce associated morbidity and mortality.

Síndrome de Boerhaave secundario a vólvulo gástrico / Boerhaave’s syndrome secondary to gastric volvulus

El síndrome de Boerhaave es una ruptura espontánea del esófago, causada por un aumento de presión intraluminal que se produce en el contexto de una presión negativa intratorácica. Tiene un alto índice de morbimortalidad (14-40%), por lo que precisa un diagnóstico y tratamiento precoces. Debería incluirse en el diagnóstico diferencial del dolor epigástrico en un paciente que ha presentado vómitos. Las hernias de hiato paraesofágicas pueden complicarse con una volvulación gástrica. Esta, a su vez, puede producir necrosis tanto esofágica como gástrica que requiere un manejo quirúrgico precoz. Presentamos el caso de un paciente de 83 años que presentó una volvulación gástrica como complicación de una hernia de hiato, con vómitos asociados que desencadenaron un síndrome de Boerhaave. Se trata del segundo caso publicado en la literatura (AU)

Boerhaave’s syndrome is a spontaneous rupture of the oesophagus, caused by an increase of intraluminal pressure that is produced in the context of negative intrathoracic pressure. It has a high index of morbimortality (14-40%), which is why it requires early diagnosis and treatment. When a patient presents vomiting, the differential diagnosis should include epigastric pain. Para-esophageal hiatal hernias can be complicated by gastric volvulus. In its turn, this can produce both oesophageal and gastric necrosis requiring early surgical treatment. We describe the case of an 83-year-old patient who presented gastric volvulus with complications from a hiatal hernia with associated vomiting, which triggered Boerhaave’s syndrome. This is the second case published in the literatura (AU)

[Boerhaave's syndrome secondary to gastric volvulus]. / Síndrome de Boerhaave secundario a vólvulo gástrico.

Boerhaave's syndrome is a spontaneous rupture of the oesophagus, caused by an increase of intraluminal pressure that is produced in the context of negative intrathoracic pressure. It has a high index of morbimortality (14-40%), which is why it requires early diagnosis and treatment. When a patient presents vomiting, the differential diagnosis should include epigastric pain. Para-esophageal hiatal hernias can be complicated by gastric volvulus. In its turn, this can produce both oesophageal and gastric necrosis requiring early surgical treatment. We describe the case of an 83-year-old patient who presented gastric volvulus with complications from a hiatal hernia with associated vomiting, which triggered Boerhaave´s syndrome. This is the second case published in the literature. Key words. Boerhaave´s syndrome. Gastric volvulus. Surgical treatment.

Results of allogeneic stem cell transplantation in the Spanish MDS registry: prognostic factors for low risk patients.

Although new agents have been approved for the treatment of MDS, the only curative approach is allogeneic hematopoietic stem cell transplantation (HSCT) and thus, in particular circumstances this procedure has been proposed as a treatment option for low risk patients. We have retrospectively analyzed the results of HSCT in 291 patients from the Spanish MDS registry with special attention to low risk MDS (LR-MDS) in order to define the variables that could impact their clinical evolution after transplantation. At 2 years OS was 51% and EFS was 50% (95% CI 0.7-4.5 years for OS and 95% CI 0.1-3.9 years for EFS). Among 43 LR-MDS, transplant-related mortality was 28%. At 3 years, OS was 67% (95% CI 264.7-8927.2 days for OS) and EFS was 64% (95% CI 0-9697.2 days for EFS). In the multivariate analysis only cytogenetics retained statistical significant effect on both OS (p=.047) and EFS (p=.046). Conditioning regimen could improve outcome among this subset of patients (OS 86% and RFS 100% for patients receiving RIC regimen). The present study confirms that specific disease characteristic as well as transplant characteristics have a significant impact on transplant outcome. Regarding low risk patients a non-myeloablative conditioning would be preferable especially in cases without high-risk cytogenetics.

The degree of neutropenia has a prognostic impact in low risk myelodysplastic syndrome.

The severity of neutropenia in myelodysplastic syndrome (MDS) has not been completely studied. We analyzed the prognostic significance of severe neutropenia (neutrophils count <0.5×10(9)/L) at diagnosis in 1109 patients with de novo MDS and low/intermediate-1 IPSS included in the Spanish MDS Registry. Severe neutropenia was present at diagnosis in 48 of 1109 (4%). Patients with severe neutropenia were most strongly represented within the groups of refractory cytopenia with multilineage dysplasia (40%) and refractory anemia with excess of blast type 1 (29%). Severe neutropenia had negative effects on the low/intermediate-1 risk group. A significant difference in overall survival was observed between patients with severe neutropenia (28 months) and patients with a neutrophil count higher than 0.5×10(9)/L (66 months) (p<0.0001). Also, severe neutropenia predicted a significantly reduced on leukemia-free survival (p<0.0001). In the multivariate analysis, severe neutropenia retained its independent prognostic influence on overall survival [HR: 2.19, 95% CI (1.41-3.10), p<0.0001] and leukemia free survival [HR: 3.51, 95% CI (1.97-6.26), p<0.0001]. The degree of neutropenia should be considered as additional prognostic factor in low/intermediate-1 IPSS MDS.

Eficacia de la versión externaprevia tocólisis con terbutalina / Efficacy of the external cephalic version with previous tocolysis with terbutaline

Objetivo: Determinar la eficacia de la versión externa previa tocólisis con terbutalina en disminuir las presentaciones de nalgas en el momento del parto. Material y métodos: Estudio prospectivo observacional en gestaciones únicas a término no complicadas, diagnosticadas de presentación de nalgas. No se excluyen cesáreas previas. Tocólisis con terbutalina. Resultados: Realizamos 43 intentos de versión externa, con un porcentaje de éxito del 55,8 por ciento de los casos. Observamos un aumento de la eficacia si se realiza antes de la semana 38 (80 por ciento) que a partir de ésta (42,9 por ciento), con unas diferencias estadísticamente significativas (p < 0,05). No se encuentran diferencias estadísticamente significativas en el porcentaje de éxito valorando la variedad de nalgas o paridad. No se han observado complicaciones en los 43 intentos. Conclusiones: La versión externa es un método válido y con baja incidencia de complicaciones para disminuir las presentaciones de nalgas en el momento del parto (AU)

[Factors influencing neurological care]. / Factores que influyen en la asistencia neurológica.

OBJECTIVE: To analyse certain factors which contribute to the existing backlog in specialised neurological care, such as: where the patient was referred from, the reason for the appointment, tests carried out and the final diagnosis. We used a random sample of patients. DESIGN: Retrospective study of patients referred from Primary Care, who were attended as out-patients in the Neurology clinic during 1991. SITE. Health Area 2 of the Autonomous Community of Madrid. MAIN MEASUREMENTS AND RESULTS: The average number of patients per doctor sent from each one of the seven Centres studied was 7.69, with outliers of between 2 and 21, with a standard deviation of 3.95 and a rate of 51.31%. The proportion of new patients to patients having follow-up checks was 2 to 3, respectively. The differences between the number of patients sent from the different centres were found in the less serious pathologies. CONCLUSIONS: We suggest that the criteria used by Primary Care professionals and specialists should be strengthened and unified. This was one of the factors which weighed most on the quality and backlog of care.

The Nonreflux Determinant of Esophagitis.

Fifty randomly selected patients were examined clinically, esophagoscopically and biopsy specimens were taken transesophagoscopically from the lower third of the esophagus. In addition, upper gastrointestinal series and gastro-secretory studies were done in all subjects. In 15 cases, in vitro DNA synthesis using tritiated thymidine was measured. No clear correlation was found between clinical manifestations, esophagoscopic appearances and histopathologic findings (Table III). Eleven (27.5%) of the 40 patients with normal esophagoscopy showed abnormal histology, whereas two of the remaining 10 patients with esophagitis by esophagoscopic criteria showed normal histology. Thus, without biopsy about one-third of the cases of histologic esophagitis can be overlooked. In the over all series, there were 19 (38%) cases with histologic esophagitis. In eight (42%) of the 19 patients with histologic esophagitis, the lesion was confined to the lamina propria. In addition to inflammatory infiltrate and fibrosis, a thickened epithelial basal layer and relatively lengthened papillae were found to be important histological signs of esophagitis. Cases with thickened basal layer showed marked labeling with radioactive DNA precursor (H3 Thymidine) after two hours of incubation, compared with the other group of patients (normal esophageal mucosa histologically or histologic esophagitis without a thickened basal layer). This is thought to be a sign of increased regeneration and repair capacity. The lamina propria did not show any labeling in either group of patients at the end of two hours. Therefore, it is concluded that the esophageal epithelium has greater regenerative capacity and can repair itself and return to a normal appearance while the inflammatory process is ongoing in the lamina propria. Besides predisposing factors such as esophagogastric sphincter dysfunction and reflux of digestive enzymes, a local tissue reaction or cell proliferation and repair capacity of theesophageal epithelium must play an important role in the development of nonspecific "peptic" esophagitis.