Reimagining physiology education with interactive content developed in H5P.

The amalgamation of educational technologies in higher education is widespread and has become essential for contemporary practice on a large scale. Foundational anatomy and physiology knowledge is integral to all courses in health education. To tackle the volume and complexity of the content taught at the foundation level, the incorporation of online tools embedded within curricula provides a unique opportunity to engage students through active learning strategies in a blended design (Means B, Toyama Y, Murphy R, Baki M. Teach Coll Rec 115: 1-47, 2013). This article reports on the use of H5P as a platform to foster self-paced and self-directed learning, critically outlining the developmental process involved in scaffolding activities to learning outcomes. The H5P activities were embedded within the online learning management system, which enabled tracking of student access to these resources. Students were asked to complete an online survey about their perspectives on the effectiveness of H5P activities. This work is part of a comprehensive study evaluating the blended design for delivery of first-year physiology subjects.

Fluctuations in measured radioactive decay rates inside a modified Faraday cage: Correlations with space weather.

For several years, reports have been published about fluctuations in measured radioactive decay time-series and in some instances linked to astrophysical as well as classical environmental influences. Anomalous behaviors of radioactive decay measurement and measurement of capacitance inside and outside a modified Faraday cage were documented by our group in previous work. In the present report, we present an in-depth analysis of our measurement with regard to possible correlations with space weather, i.e. the geomagnetic activity (GMA) and cosmic-ray activity (CRA). Our analysis revealed that the decay and capacitance time-series are statistically significantly correlated with GMA and CRA when specific conditions are met. The conditions are explained in detail and an outlook is given on how to further investigate this important finding. Our discovery is relevant for all researchers investigating radioactive decay measurements since they point out that the space weather condition during the measurement is relevant for partially explaining the observed variability.

Strong Dependence of Atmospheric Feedbacks on Mixed-Phase Microphysics and Aerosol-Cloud Interactions in HadGEM3.

We analyze the atmospheric processes that explain the large changes in radiative feedbacks between the two latest climate configurations of the Hadley Centre Global Environmental model. We use a large set of atmosphere-only climate change simulations (amip and amip-p4K) to separate the contributions to the differences in feedback parameter from all the atmospheric model developments between the two latest model configurations. We show that the differences are mostly driven by changes in the shortwave cloud radiative feedback in the midlatitudes, mainly over the Southern Ocean. Two new schemes explain most of the differences: the introduction of a new aerosol scheme and the development of a new mixed-phase cloud scheme. Both schemes reduce the strength of the preexisting shortwave negative cloud feedback in the midlatitudes. The new aerosol scheme dampens a strong aerosol-cloud interaction, and it also suppresses a negative clear-sky shortwave feedback. The mixed-phase scheme increases the amount of cloud liquid water path (LWP) in the present day and reduces the increase in LWP with warming. Both changes contribute to reducing the negative radiative feedback of the increase of LWP in the warmer climate. The mixed-phase scheme also enhances a strong, preexisting, positive cloud fraction feedback. We assess the realism of the changes by comparing present-day simulations against observations and discuss avenues that could help constrain the relevant processes.

IGF-1 Mediates EphrinB1 Activation in Regulating Tertiary Dentin Formation.

Eph receptors belong to a subfamily of receptor tyrosine kinases that are activated by membrane-spanning ligands called ephrins. Previously, we demonstrated that the ephrinB1-EphB2 interaction regulates odontogenic/osteogenic differentiation from dental pulp cells (DPCs) in vitro. The goal of this study was to identify the molecular mechanisms regulated by the EphB2/ephrinB1 system that govern tertiary dentin formation in vitro and in vivo. During tooth development, ephrinB1, and EphB2 were expressed in preodontoblast and odontoblasts at postnatal day 4. EphrinB1 was continuously expressed in odontoblasts and odontoblastic processes until the completion of tooth eruption. In addition, ephrinB1 was expressed in odontoblastic processes 2 wk following tooth injury without pulp exposure, whereas EphB2 was expressed in the center of pulp niches but not odontoblasts. In a model of tooth injury with pulp exposure, ephrinB1 was strongly expressed in odontoblasts 4 wk postinjury. In vitro studies with human and mouse DPCs treated with calcium hydroxide (CH) or mineral trioxide aggregate (MTA) showed an increased expression of insulin-like growth factor 1 (IGF-1). Experiments using several inhibitors of IGF-1 receptor signaling revealed that inhibiting the Ras/Raf-1/MAPK pathway inhibited EphB2 expression, and inhibiting the PI3K/Akt/mTOR pathway specifically inhibited ephrinB1 gene expression. Tooth injury in mice with odontoblast-specific IGF-1 receptor ablation exhibited a reduced tertiary dentin volume, mineral density, and ephrinB1 expression 4 wk following injury. We conclude that the IGF-1/ephrinB1 axis plays significant roles in the early stages of tooth injury. Further research is needed to fully understand the potential of targeting ephrinB1 as a regenerative pulp therapy.

Ecobroncoscopia / No disponible

La ecografía endobronquial (EBUS: endobronchial ultrasound) combina en un endoscopio flexible dos sistemas de imagen: uno óptico, idéntico al de los broncoscopios convencionales y una sonda de ecografía. Existen dos tipos de ecobroncoscopios: lineal/sectorial y radial. El primero disponible fue el ecobroncoscopio radial, pero en la actualidad el más utilizado es el lineal. Las principales indicaciones de la ecobroncoscopia radial se refieren al estudio de lesiones pulmonares periféricas y a la exploración de la pared traqueobronquial para ver si existe infiltración neoplásica o no. Su principal desventaja es que no permite la toma de muestras en tiempo real. Sus complicaciones son las mismas que una broncoscopia convencional con reali-zación de biopsias transbronquiales siendo, por tanto, una técnica segura y muy eficaz. La ecobroncoscopia lineal tiene como principal indicación la estadificación mediastínica en pacientes con sospecha o previamente diagnosticados de cáncer de pulmón primario o metastático, aunque también se utiliza para la evaluación mediastínica en otras patologías. El uso de Doppler color permite la diferenciación de estructuras vasculares, lo que hace la técnica más segura. Su principal ventaja respecto a la ecobroncoscopia radial es que permite la punción en tiempo real. Es una técnica segura, cuya tasa de complicaciones es muy baja (1,5%)

No disponible

Genomic signature of successful colonization of Eurasia by the allopolyploid shepherd's purse (Capsella bursa-pastoris).

Polyploidization is a dominant feature of flowering plant evolution. However, detailed genomic analyses of the interpopulation diversification of polyploids following genome duplication are still in their infancy, mainly because of methodological limits, both in terms of sequencing and computational analyses. The shepherd's purse (Capsella bursa-pastoris) is one of the most common weed species in the world. It is highly self-fertilizing, and recent genomic data indicate that it is an allopolyploid, resulting from hybridization between the ancestors of the diploid species Capsella grandiflora and Capsella orientalis. Here, we investigated the genomic diversity of C. bursa-pastoris, its population structure and demographic history, following allopolyploidization in Eurasia. To that end, we genotyped 261 C. bursa-pastoris accessions spread across Europe, the Middle East and Asia, using genotyping-by-sequencing, leading to a total of 4274 SNPs after quality control. Bayesian clustering analyses revealed three distinct genetic clusters in Eurasia: one cluster grouping samples from Western Europe and Southeastern Siberia, the second one centred on Eastern Asia and the third one in the Middle East. Approximate Bayesian computation (ABC) supported the hypothesis that C. bursa-pastoris underwent a typical colonization history involving low gene flow among colonizing populations, likely starting from the Middle East towards Europe and followed by successive human-mediated expansions into Eastern Asia. Altogether, these findings bring new insights into the recent multistage colonization history of the allotetraploid C. bursa-pastoris and highlight ABC and genotyping-by-sequencing data as promising but still challenging tools to infer demographic histories of selfing allopolyploids.

Limited genomic consequences of mixed mating in the recently derived sister species pair, Collinsia concolor and Collinsia parryi.

Highly selfing species often show reduced effective population sizes and reduced selection efficacy. Whether mixed mating species, which produce both self and outcross progeny, show similar patterns of diversity and selection remains less clear. Examination of patterns of molecular evolution and levels of diversity in species with mixed mating systems can be particularly useful for investigating the relative importance of linked selection and demographic effects on diversity and the efficacy of selection, as the effects of linked selection should be minimal in mixed mating populations, although severe bottlenecks tied to founder events could still be frequent. To begin to address this gap, we assembled and analysed the transcriptomes of individuals from a recently diverged mixed mating sister species pair in the self-compatible genus, Collinsia. The de novo assembly of 52 and 37 Mbp C. concolor and C. parryi transcriptomes resulted in ~40 000 and ~55 000 contigs, respectively, both with an average contig size ~945. We observed a high ratio of shared polymorphisms to fixed differences in the species pair and minimal differences between species in the ratio of synonymous to replacement substitutions or codon usage bias implying comparable effective population sizes throughout species divergence. Our results suggest that differences in effective population size and selection efficacy in mixed mating taxa shortly after their divergence may be minimal and are likely influenced by fluctuating mating systems and population sizes.

[Key elements for patients and caregivers in the process of living with Parkinson's disease]. / Elementos clave en el proceso de convivencia con la enfermedad de Parkinson de pacientes y familiares cuidadores.

BACKGROUND: Parkinson's disease has a considerable impact on people's lives. It is necessary to identify the key elements that influence the process of living with Parkinson's disease so that health professionals can help patients and their relatives to live as well as possible with the changes and limitations produced by the disease. MATERIAL AND METHODS: A qualitative descriptive study was realized. This study corresponded to the first phase of a sequential, exploratory design (mixed method) that in turn included a quantitative phase. A multicentre project was carried out. Convenience sampling was applied to collect data, a semi-structured interview was realized individually with patients and carer-relatives and two questionnaires with patients: the Hoehn & Yahr scale and the PDNMS questionnaire. Content analysis of the interviews and a statistical description of the questionnaires were used. RESULTS: The sample was made up of 46 participants. Three key elements were identified in the process of living with Parkinson's disease: acceptance, adaptation and self-management. These elements conditioned the modes of living with Parkinson's disease: positive living, characterized by feelings of harmony, balance and naturalness; negative living characterized be feelings of frustration, loss of control and self-esteem. CONCLUSIONS: It is essential for health professionals to have a deep understanding of these elements, as well as of the factors that favor or hinder them. To the extent that research in this field progresses and effective interventions are identified, comprehensive patient care will be improved in consonance with the new directives for chronicity.

Elementos clave en el proceso de convivencia con la enfermedad de Parkinson de pacientes y familiares cuidadores / Key elements in the process of living with Parkinson’s disease for patiens and caregivers

Fundamento: La enfermedad de Parkinson produce un impacto considerable en la vida de las personas. Es necesario identificar los elementos clave que influyen en el proceso de convivencia con la enfermedad de Parkinson para que los profesionales de la salud puedan ayudar a los pacientes y sus familias a convivir lo mejor posible con los cambios y limitaciones producidos por la enfermedad. Material y método: Se llevó a cabo un estudio cualitativo descriptivo. Este estudio se corresponde con la primera fase de un diseño exploratorio secuencial (Mixed-methods) que incluye a su vez una fase cuantitativa. Se realizó un proyecto multicéntrico. Para la recogida de datos se aplicó un muestreo de conveniencia y se utilizó una entrevista semi-estructurada realizada individualmente a pacientes y familiares cuidadores y dos cuestionarios para pacientes: la Escala de Hoehn & Yahry el Cuestionario PDNMS. Se realizó un análisis de contenido de las entrevistas y estadístico descriptivo de los cuestionarios. Resultados: La muestra la constituyeron 46 participantes. Se identificaron tres elementos clave en el proceso de convivencia con la enfermedad de Parkinson: aceptación, adaptación y automanejo. Estos elementos condicionaron dos modos de convivencia con la enfermedad de Parkinson: una convivencia positiva, caracterizada por sentimientos de armonía, equilibrio, y naturalidad; y una convivencia negativa caracterizada por sentimientos de frustración, pérdida de control y autoestima. Conclusiones: Es esencial que los profesionales de la salud conozcan a fondo estos elementos, así como los factores que los favorecen o dificultan. En la medida que se propicie la investigación en este ámbito y se identifiquen intervenciones efectivas se mejorará la atención integral de la personas en consonancia con las nuevas directrices para la cronicidad (AU)

Background: Parkinson's disease has a considerable impact on people’s lives. It is necessary to identify the key elements that influence the process of living with Parkinson’s disease so that health professionals can help patients and their relatives to live as well as possible with the changes and limitations produced by the disease. Material and methods: A qualitative descriptive study was realized. This study corresponded to the first phase of a sequential, exploratory design (mixed method) that in turn included a quantitative phase. A multicentre project was carried out. Convenience sampling was applied to collect data, a semi-structured interview was realized individually with patients and carer-relatives and two questionnaires with patients: the Hoehn & Yahr scale and the PDNMS questionnaire. Content analysis of the interviews and a statistical description of the questionnaires were used. Results: The sample was made up of 46 participants. Three key elements were identified in the process of living with Parkinson’s disease: acceptance, adaptation and self-management. These elements conditioned the modes of living with Parkinson’s disease: positive living, characterized by feelings of harmony, balance and naturalness; negative living characterized be feelings of frustration, loss of control and self-esteem. Conclusions: It is essential for health professionals to have a deep understanding of these elements, as well as of the factors that favor or hinder them. To the extent that research in this field progresses and effective interventions are identified, comprehensive patient care will be improved in consonance with the new directives for chronicity (AU)

Protocolo de actuación ante una neumonía que no se resuelve / Protocol for action in the event of non-resolving pneumonia

Las infecciones agudas del tracto respiratorio inferior son las más frecuentes en la edad pediátrica; aproximadamente el 1,5% de ellas son neumonías. La incidencia de la neumonía es difícil de establecer, al tratarse de un proceso benigno sin obligación oficial de declararse, aunque se estima en 15-40/1.000 niños al año, según la edad. Las neumonías son la principal causa de morbilidad respiratoria en el mundo y la tercera causa de muerte en los países desarrollados. Su resolución es habitual, aunque en ciertas ocasiones la evolución clínica y radiológica no es favorable a pesar de realizar un tratamiento supuestamente adecuado, lo que obliga a llevar a cabo una sistemática diagnóstica para intentar aclarar las causas de esta evolución anormal a fin de realizar un tratamiento correcto (AU)

Acute lower respiratory tract infections (LRTIs) are the most common infections in children; approximately 1.5% of those infections are pneumonias. It is difficult to establish the incidence of pneumonia since it is a benign process with no official reporting obligation, but it is estimated that there are 15 to 40cases per thousand children and year according to age. Pneumonias are the main cause of respiratory morbidity worldwide and the third cause of death in developed countries; commonly, resolution is the norm. However, in some cases the clinical and radiological evolution is not favourable in spite of a supposedly appropriate treatment. In those cases, a systematic diagnosis is required in order to clarify the causes of the abnormal evolution and establish a correct treatment (AU)

Programa de control y seguimiento de ventilación no invasiva domiciliaria en pacientes pediátricos. Unidad multidisciplinar / Non invasive home control and follow –up program in pediatric patients. A multidisciplinary Unit

La ventilación mecánica no invasiva constituye una nueva modalidad de terapia de soporte respiratorio en la que no se precisa invadir, mediante traqueostomía o intubación endotraqueal, la vía aérea. Se utiliza en pacientes con fallo respiratorio agudo o crónico como alternativa menos agresiva a la ventilación mecánica convencional, buscando evitar las complicaciones asociadas a la intubación endotraqueal y mejorar la calidad de vida del enfermo. Durante los últimos 5-10 años se ha generalizado su uso, debido en gran parte a los avances médicos y tecnológicos que han contribuido al aumento de supervivencia del paciente crítico, al mejor diagnóstico y conocimiento de enfermedades que cursan con aumento de resistencias de la vía aérea superior o con hipoventilación central o periférica así como al desarrollo de nuevos aparatos de fácil manejo adaptados al tratamiento domiciliario. La creación de un programa de control y seguimiento de ventilación no invasiva domiciliaria en pacientes pediátricos va a producir mejoras psicosociales para el paciente y su familia y beneficios económicos para el sistema de salud. En esta revisión nos vamos a referir al tratamiento ambulatorio y domiciliario de niños con insuficiencia respiratoria crónica y a la necesidad de creación de unidades especializadas multidisciplinares de intervención en este tipo de enfermos (AU)

Non-invasive mechanical ventilation is a new respiratory support therapy modality in which it is not necessary to invade the airway with tracheostomy or endotracheal intubation. It is used in patients with acute or chronic respiratory failure as a less aggressive alternative to conventional mechanical ventilation, seeking to avoid the complications associated to endotracheal intubation and to improve the patient´s quality of life. During the last 5-10 years, its use has become generalized, largely due to the medical and technological advances that have contributed to the increased survival of the critical patients, to the better diagnosis and knowledge of diseases that occur with increased resistances of the upper airway or with central and/or peripheral hypoventilation and to the development of new easily used apparatus adapted to home treatment. The creation of a control and follow-up program of non-invasive home ventilation in pediatric patients will produce psychosocial and economic benefits for the health care system. In this review, we are going to mention the out-patient and home treatment of children with chronic respiratory failure and the need to create specialized multidisciplinary intervention units in this type of patient (AU)

Evidence for biological nitrification inhibition in Brachiaria pastures.

Nitrification, a key process in the global nitrogen cycle that generates nitrate through microbial activity, may enhance losses of fertilizer nitrogen by leaching and denitrification. Certain plants can suppress soil-nitrification by releasing inhibitors from roots, a phenomenon termed biological nitrification inhibition (BNI). Here, we report the discovery of an effective nitrification inhibitor in the root-exudates of the tropical forage grass Brachiaria humidicola (Rendle) Schweick. Named "brachialactone," this inhibitor is a recently discovered cyclic diterpene with a unique 5-8-5-membered ring system and a gamma-lactone ring. It contributed 60-90% of the inhibitory activity released from the roots of this tropical grass. Unlike nitrapyrin (a synthetic nitrification inhibitor), which affects only the ammonia monooxygenase (AMO) pathway, brachialactone appears to block both AMO and hydroxylamine oxidoreductase enzymatic pathways in Nitrosomonas. Release of this inhibitor is a regulated plant function, triggered and sustained by the availability of ammonium (NH(4)(+)) in the root environment. Brachialactone release is restricted to those roots that are directly exposed to NH(4)(+). Within 3 years of establishment, Brachiaria pastures have suppressed soil nitrifier populations (determined as amoA genes; ammonia-oxidizing bacteria and ammonia-oxidizing archaea), along with nitrification and nitrous oxide emissions. These findings provide direct evidence for the existence and active regulation of a nitrification inhibitor (or inhibitors) release from tropical pasture root systems. Exploiting the BNI function could become a powerful strategy toward the development of low-nitrifying agronomic systems, benefiting both agriculture and the environment.

Manejo del síndrome aspirativo recurrente en el paciente pediátrico / Treatment of recurrent aspiration syndrome in children

El síndrome aspirativo recurrente es una causa importante de patología broncopulmonar. En su etiopatogenia intervienen alteraciones de la deglución, la presencia de reflujo gastroesofágico y la aspiración de saliva. Debido a su presentación clínica variable y a la inexistencia de criterios diagnósticos específicos, frecuentemente pasa desapercibido. El tratamiento debe plantearse en función del mecanismo implicado, evaluando los posibles factores predisponentes en cada paciente. Presentamos el caso de una niña que fue remitida a la consulta de neumología tras sufrir episodios respiratorios de repetición, con una inadecuada respuesta al tratamiento. Se hace una revisión exhaustiva de esta patología en el contexto pediátrico con el fin de definir una norma de actuación diagnóstica adecuada, evitar la realización de pruebas complementarias excesivas e inapropiadas y llevar a cabo una terapia dirigida y fundamentada (AU)

Recurrent aspiration syndrome is an important cause of bronchopulmonary pathology. Its etiopathogenesis involves wallowing alterations, the presence of gastroesophageal reflux and the aspiration of saliva. Because of its variable clinical presentation and the absence of specific diagnostic criteria, it often goes unnoticed. The treatment should be determined according to the mechanism involved, thereby evaluating the potential predisposing factors in each patient. We present the case of a girl who is referred to the Pneumology Department because of recurrent respiratory episodes and a poor response to the treatment. An in-depth review is conducted of this pathology in the field of paediatrics, with the aim of defining rules for adequate diagnostic action, there by trying to avoid excessive and inappropriate additional tests, and providing a targeted and justified therapy (AU)

[Forced spirometry in healthy preschool children]. / Espirometría forzada en preescolares sanos bajo las recomendaciones de la ATS/ERS: estudio CANDELA.

INTRODUCTION: Reference values for spirometry in healthy preschool children have not yet been obtained in accordance with American Thoracic Society (ATS) and the European Respiratory Society (ERS) guidelines. The objective was to establish reference values for spirometry in healthy preschoolers under the ATS/ERS 2007 statement. MATERIAL AND METHOD: Children of at least 2 and under 7 years of age were tested in 9 pediatric pulmonary function laboratories. The technicians were trained to apply a standardized protocol to perform spirometry. RESULTS: Valid spirometry results were obtained in 455 (81.54%) out of 558 children: 242 boys (53.2%) and 213 girls (46.8%). Ages were as follows: 31 at least 2 and under 3 years old; 96, at least 3 and under 4; 108, at least 4 and under 5; 122, at least 5 and under 6 years, and 98, at least 6 and under 7 years. Formulas were used to calculate the reference values for all the spirometry variables in preschoolers. CONCLUSIONS: Spirometry is feasible in the majority of preschool children under the new guidelines. The availability of the reference values presented is an important step, both for the care of preschoolers and for further research on pulmonary function.

Patología respiratoria en pacientes con enfermedad de células falciformes. Protocolo de actuación (y II) / Respiratory disorders in patients with sickle cell disease. Management protocol (II)

La drepanocitosis es una hemoglobinopatía que produce rigidez del eritrocito en situaciones de hipoxia, infección o deshidratación, con la consecuente oclusión microvascular y hemólisis. Es una enfermedad que afecta a múltiples órganos y sistemas, como el bazo, el sistema nervioso central, el aparato osteoarticular, los ojos, el sistema genitourinario y el aparato respiratorio. La patología respiratoria, tanto aguda como crónica, es una causa importante de morbimortalidad, aunque lo que más afecta a la calidad de vida de estos pacientes son las crisis dolorosas. En este artículo vamos a revisar las diferentes complicaciones respiratorias con el fin de realizar una prevención adecuada y efectuar un tratamiento precoz y agresivo de las mismas. También describiremos brevemente el resto de situaciones que pueden aparecer a lo largo de la evolución de la enfermedad y expondremos de forma esquemática el programa de control y seguimiento del paciente con enfermedad de células falciformes(ECF).Asimismo, revisaremos también el interés de la puesta en marcha de grupos de trabajo especializados en esta patología aún poco conocida en nuestro medio, aunque se está incrementando su detección debido a la inmigración y a la realización del cribado neonatal, que obliga a la elaboración de un plan de actuación mediante la creación de unidades multidisciplinares que van a mejorar sobremanera la supervivencia y calidad de vida de estos enfermos (AU)

Sickle cell disease is a hemoglobinopathy that produces stiffness in red cells in situations of hypoxia, infection or dehydration, with the subsequent microvascular occlusion and hemolysis. It is a disease that affects multiple organs and systems, such as the spleen, the central nervous system, the osteoarticular apparatus, the eyes, the genitourinary system and the respiratory system. The respiratory disease, both acute and chronic, is a majorcause of morbidity and mortality, although painful crises have a greater effect on the quality of life of these patients. In this article, we will elaborate upon the various respiratory complications with the aim of providing proper prevention and treating them early and aggressively. We will also briefly describe the other situations that may occur throughout the course of the disease and schematically explain a control and monitoring program for patients with sickle cell disease. This article will also stress the interest in establishing specialized workgroups in this disease, which is still not very well known in Spain, although its detection is increasing due to immigration, and due to the universal newborn screening in some autonomous regions. This circumstance makes it necessary to develop an action plan through the creation of multidisciplinary units that will greatly improve the survival and quality of life of these patients (AU)

Patología respiratoria en pacientes con enfermedad de células falciformes. Protocolo de actuación (I) / Respiratory disorders in patients with sickle cell disease: management protocol (I)

La drepanocitosis es una hemoglobinopatía que produce rigidez del eritrocito en situaciones de hipoxia, infección o deshidratación, con la consecuente oclusión microvascular y hemólisis. Es una enfermedad que afecta a múltiples órganos y sistemas, como el bazo, el sistema nervioso central, el aparato osteoarticular, los ojos, el sistema genitourinario y el aparato respiratorio. La patología respiratoria, tanto aguda como crónica, es una causa importante de morbimortalidad, aunque las crisis dolorosas afectan más a la calidad de vida de estos pacientes. Vamos a desarrollar a lo largo de este artículo las diferentes complicaciones respiratorias, con el fin de realizar una prevención adecuada y efectuar un tratamiento precoz y agresivo de ellas. También describiremos brevemente el resto de situaciones que pueden aparecer durante la evolución de la enfermedad y expondremos esquemáticamente el programa de control y seguimiento del paciente con enfermedad de células falciformes. Se resalta también el interés de la puesta en marcha de grupos de trabajo especializados en esta patología aún poco conocida en nuestro medio, aunque se está incrementando su detección debido a la inmigración y a la realización del cribado neonatal universal en algunas comunidades autónomas, lo que obliga a la elaboración de un plan de actuación mediante la creación de unidades multidisciplinarias que van a mejorar sobremanera la supervivencia y la calidad de vida de estos pacientes (AU)

Sickle-cell disease is a hemoglobinopathy that produces rigidity in red cells under conditions of hypoxia, infection or dehydration, with the subsequent microvascular occlusion and hemolysis. It is a disease that affects multiple organs and systems, such as the spleen, the central nervous system, the osteoarticular system, the eyes, the genitourinary tract and the respiratory tract. Respiratory diseases, both acute and chronic, are a major cause of morbidity and mortality, although painful crises have a greater impact on the quality of life of these patients. In this article, we will elaborate upon the various respiratory complications for the purpose of introducing proper preventive measures and initiating an early and aggressive treatment of these complications. We will also briefly describe other situations that may arise throughout the course of the disease and briefly describe a program for the control and monitoring ofpatients with sickle cell disease. This article will also highlight the interest in establishing specialized workgroups in this disease. Although it is still not very widespread among our general population, it is being detected with increasing frequency due to immigration, and due to the universal newborn screening in some autonomous regions, which calls for the development of a plan of action through the creation of multidisciplinary units that will greatly improve the survival and quality of life of these patients (AU)

Micellar electrokinetic chromatographic method for the determination of letrozole, citalopram and their metabolites in human urine.

A new micellar electrokinetic chromatographic method has been developed to analyse human urine samples containing a combination of a drug used for the treatment of breast cancer (letrozole), an antidepressant (citalopram) and their main metabolites. Best results were obtained by using 15 mM borate buffer (pH 9.2) containing 20 mM sodium dodecyl sulphate and 12% (v/v) 2-propanol as the background electrolyte. The separation was performed through a fused silica capillary at 40 degrees C with the application of 6s (3.45 kPa) of hydrodynamic injection and 30 kV of separation voltage. Detection wavelength was 240 nm. Under these conditions, the migration times for all the studied compounds were ranged between 3.0 and 8.0 min. Linearity ranges were determined as 0.4-5.0 microg/mL for all the compounds. Detection limits between 12.5 and 25 ng/mL were determined in urine samples. According to the validation study, the developed method has been proven to be accurate, precise, sensitive, specific, rugged and robust. This method has been used to determine letrozole, citalopram and their metabolites in human urine at clinical levels. Prior to determination, the samples are purified and enriched by means of an extraction-preconcentration step with a preconditioned C(18) cartridge and by eluting the compounds with methanol. The developed method was applied to the determination of these analytes in three urine samples from patients undergoing treatment with letrozole or citalopram.

Micellar electrokinetic chromatographic study of the separation of an aromatase inhibitor and a tryciclic antidepressant in the breast cancer treatment.

Micellar electrokinetic chromatography (MEKC) was investigated for the simultaneous determination of letrozole, imipramine and their metabolites in human urine samples over a concentration range of therapeutic interest. Experimental parameters such as pH of the running electrolyte, sodium dodecylsulphate (SDS) concentration, borate concentration, voltage, etc were investigated. Under optimal conditions of 25 mM SDS, 15 mM borate buffer (pH 9.2), 15% 2-propanol, as background electrolyte; 28 kV and 40 degrees C, as voltage and cartridge temperature, respectively; resolution between the peaks was greater than 1.7. Before the determination, a solid phase extraction (SPE) procedure with a C(18) cartridge was optimized. Good linearity, accuracy, precision, robustness and ruggedness were achieved and detection limits of 12.5 ng/mL for letrozole and its metabolite and 37.5 ng/mL, were obtained for imipramine and their metabolites. Real determinations of these analytes in two patient urines were carried out. Sensitivity achieved in this method is sufficient to perform kinetic studies in humans.

Protocolo de actuación en pacientes con displasia broncopulmonar/enfermedad pulmonar crónica (y II) / Protocol for the management of patients with bronchopulmonary dysplasia/chronic lung disease (and II)

La displasia broncopulmonar/enfermedad pulmonar crónica de la infancia constituye un grupo heterogéneo de enfermedades respiratorias cada vez más frecuentes en nuestro medio debido, principalmente, a una mayor supervivencia de los recién nacidos de extremado bajo peso. Es una patología multisistémica muy compleja, con una etiopatogenia multifactorial, un cuadro clínico variado con participación de diferentes aparatos y sistemas, así como con muy diversas posibilidades diagnósticas y terapéuticas, que deberán conocerse en profundidad para establecer un buen control de esta enfermedad. Por ello, se requiere un seguimiento individualizado y un abordaje multidisciplinar, en el que es necesaria la implantación de un programa bien estructurado de intervención y seguimiento. El objetivo de este trabajo es exponer los principales problemas asociados a los pacientes con displasia broncopulmonar/ enfermedad pulmonar crónica de la infancia, así como elaborar un plan de actuación tras el alta del servicio de neonatología

Bronchopulmonary dysplasia vs. chronic lung disease of infancy constitutes a heterogeneous group of respiratory diseases that are increasingly frequent in our general population, mainly due to the greater survival of very low birth weight infants. It is a very complex, multisystemic disease with a multifactorial etiology and pathogenesis. The clinical features vary widely, with participation of different organs and systems, as well as very diverse diagnostic and therapeutic possibilities. All these aspects should be studied in depth to achieve effective control of this disease. For this reason, an individualized follow-up and a multidisciplinary approach are required, for which the introduction of a well-structured program of intervention and control is necessary. The objective of this article is to discuss the major problems associated with patients with bronchopulmonary dysplasia/ chronic lung disease in infancy and to propose a plan for the management of these infants after their discharge from the neonatology service