Papel del radiofarmacéutico clínico en la seguridad del paciente durante los estudios de perfusión miocárdica de esfuerzo con vasodilatadores / Role of the clinical radiopharmacist in patient safety during myocardial perfusion imaging with vasodilator stress agents

Objetivos: Evaluar el papel del radiofarmacéutico en un equipo multidisciplinar en la detección de contraindicaciones del regadenosón para su uso seguro en pacientes a los que se solicitó una SPECT de perfusión miocárdica. Métodos: Se estudió ambispectivamente su uso seguro en 1.905 pacientes (54,1% mujeres, edad media: 66,6±11,7 años, rango: 20-95años). Se registraron datos relativos al sexo, a la edad, al historial médico, a la medicación, a las alergias medicamentosas y a las contraindicaciones para el estrés farmacológico, así como las recomendaciones realizadas al médico nuclear responsable. Resultados: Las contraindicaciones detectadas y las correspondientes recomendaciones fueron las siguientes: riesgo de prolongación del intervalo QTc (7,5%): comprobación previa del intervalo QTc y monitorización del ECG; ictus o AIT previo (4,2%): evaluación de estenosis carotídea; alergia a salicilatos y/o sulfamidas (3,1%): empleo de [99mTc]Tc-MIBI; epilepsia o riesgo de convulsiones (2,4%): uso de adenosina o reconsiderar su indicación; tratamiento con corticosteroides sistémicos en EPOC severa (1,3%): reevaluar las condiciones del paciente; EPOC reagudizada (0,8%): posponer hasta la resolución del episodio agudo; asma grave (0,4%): no realizar la prueba; toma de metilxantinas (0,3%): evitar su consumo previo; otras (6,1%): evaluación de cada contraindicación. No se observaron contraindicaciones en el 73,6% de los pacientes. Se anularon el 2,9% de las peticiones debido a contraindicaciones absolutas. Conclusiones: Empleando una metodología de trabajo sistemática, el radiofarmacéutico detectó un elevado número de incidencias, presentando uno de cada cuatro pacientes alguna contraindicación clínica. Las recomendaciones emitidas fueron aceptadas por los médicos nucleares, que modificaron su enfoque, incrementando así la seguridad de estos pacientes.(AU)

Aim: To assess the radiopharmacist's role in a multidisciplinary team focused on the contraindications of regadenoson in order to ensure the safe use of pharmacologic vasodilator stress agents in patients undergoing SPECT-MPI. Methods: We ambispectively studied its safe use in 1905 patients (54.1% female, mean age: 66.6±11.7 years, range: 20-95years). Sex, age, medical history, medications, drug allergies, and contraindications for stress testing were registered together with recommendations for the nuclear physician in charge. Results: Detected contraindications and corresponding recommendations were as follows: risk factors for QTc interval prolongation 7.5% — measurement of QTc interval previously to test and monitor ECG; prior stroke or TIA 4.2% — consider carotid stenosis assessment; salicylates/sulfonamides allergy 3.1% — use 99mTc-sestamibi; epilepsy or risk factors for seizures 2.4% — use of adenosine or reconsider test indication; systemic corticosteroid therapy for severe COPD 1.3% — reassessment of patient's condition; acute exacerbation of COPD 0.8% — defer test until acute episode is over; severe asthma 0.4% — do not perform test; methylxanthine ingestion 0.3% — avoid consumption previously; other 6.1% — evaluation of other contraindications. No contraindications were detected in 73.6% of patients. The test was cancelled due to absolute contraindications in 2.9% of the requests. Conclusions: Working in a systematic way, the radiopharmacist was able to detect a high number of issues related to regadenoson, with one out of four patients presenting some clinical contraindication. The recommendations given by the radiopharmacist were well accepted by the nuclear physicians who changed their approach contributing to increase the safety of patients referred for MPI.(AU)

Role of the clinical radiopharmacist in patient safety during myocardial perfusion imaging with vasodilator stress agents.

AIM: To assess the radiopharmacist's role in a multidisciplinary team focused on the contraindications of regadenoson in order to ensure the safe use of pharmacologic vasodilator stress agents in patients undergoing SPECT-MPI. METHODS: We ambispectively studied its safe use in 1905 patients (54.1% female, mean age: 66.6±11.7 years, range: 20-95 years). Sex, age, medical history, medications, drug allergies, and contraindications for stress testing were registered together with recommendations for the nuclear physician in charge. RESULTS: Detected contraindications and corresponding recommendations were as follows: risk factors for QTc interval prolongation 7.5% - measurement of QTc interval previously to test and monitor ECG; prior stroke or TIA 4.2% - consider carotid stenosis assessment; salicylates/sulfonamides allergy 3.1% - use 99mTc-sestamibi; epilepsy or risk factors for seizures 2.4% - use of adenosine or reconsider test indication; systemic corticosteroid therapy for severe COPD 1.3% - reassessment of patient's condition; acute exacerbation of COPD 0.8% - defer test until acute episode is over; severe asthma 0.4% - do not perform test; methylxanthine ingestion 0.3% - avoid consumption previously; other 6.1% - evaluation of other contraindications. No contraindications were detected in 73.6% of patients. The test was canceled due to absolute contraindications in 2.9% of the requests. CONCLUSIONS: Working in a systematic way, the radiopharmacist was able to detect a high number of issues related to regadenoson, with one out of four patients presenting some clinical contraindication. The recommendations given by the radiopharmacist were well accepted by the nuclear physicians who changed their approach contributing to increase the safety of patients referred for MPI.

Demonstrating Agreement between Radio and Fluorescence Measurements of the Depth of Maximum of Extensive Air Showers at the Pierre Auger Observatory.

We show, for the first time, radio measurements of the depth of shower maximum (X_{max}) of air showers induced by cosmic rays that are compared to measurements of the established fluorescence method at the same location. Using measurements at the Pierre Auger Observatory we show full compatibility between our radio and the previously published fluorescence dataset, and between a subset of air showers observed simultaneously with both radio and fluorescence techniques, a measurement setup unique to the Pierre Auger Observatory. Furthermore, we show radio X_{max} resolution as a function of energy and demonstrate the ability to make competitive high-resolution X_{max} measurements with even a sparse radio array. With this, we show that the radio technique is capable of cosmic-ray mass composition studies, both at Auger and at other experiments.

The Sympathetic Nervous System Is Necessary for Development of CD4+ T-Cell Memory Following Staphylococcus aureus Infection.

Lymph nodes and spleens are innervated by sympathetic nerve fibers that enter alongside arteries. Despite discovery of these nerve fibers nearly 40 years ago, the role of these nerves during response to infection remains poorly defined. We have found that chemical depletion of sympathetic nerve fibers compromises the ability of mice to develop protective immune memory to a Staphylococcus aureus infection. Innate control of the primary infection was not impacted by sympathectomy. Germinal center formation is also compromised in nerve-depleted animals; however, protective antibody responses are still generated. Interestingly, protective CD4+ T-cell memory fails to form in the absence of sympathetic nerves after S aureus infection.

Limits to Gauge Coupling in the Dark Sector Set by the Nonobservation of Instanton-Induced Decay of Super-Heavy Dark Matter in the Pierre Auger Observatory Data.

Instantons, which are nonperturbative solutions to Yang-Mills equations, provide a signal for the occurrence of quantum tunneling between distinct classes of vacua. They can give rise to decays of particles otherwise forbidden. Using data collected at the Pierre Auger Observatory, we search for signatures of such instanton-induced processes that would be suggestive of super-heavy particles decaying in the Galactic halo. These particles could have been produced during the post-inflationary epoch and match the relic abundance of dark matter inferred today. The nonobservation of the signatures searched for allows us to derive a bound on the reduced coupling constant of gauge interactions in the dark sector: α_{X}≲0.09, for 10^{9}≲M_{X}/GeV<10^{19}. Conversely, we obtain that, for instance, a reduced coupling constant α_{X}=0.09 excludes masses M_{X}≳3×10^{13} GeV. In the context of dark matter production from gravitational interactions alone, we illustrate how these bounds are complementary to those obtained on the Hubble rate at the end of inflation from the nonobservation of tensor modes in the cosmological microwave background.

Localization and Delocalization in Solids from Electron Distribution Functions.

The extent of electron localization and delocalization in molecular and condensed phases has been the subject of intense scrutiny over the years. In Chemistry, where real, instead of momentum space viewpoints are many times closer to intuition, a plethora of localization descriptors exist, including a family of indices invariant under orbital transformations that rely only on an underlying partition of the physical space into meaningful regions. These localization and delocalization indices measure the fluctuation of the electron population contained in such domains, and have been rigorously related to the insulating or conductive character of extended systems. Knowledge of the full electron population probability distribution function is also available in molecules, where it has provided many meaningful results as well as uncovered exotic interaction regimes in excited states. Electron distribution functions (EDFs), which can be seen as real space analogs of Pauling resonance structures, are now reported in periodic systems. In agreement with what is known in finite systems, ionic compounds display narrow EDFs that get wider as covalency sets in. Contrarily to conventional wisdom, most electrons delocalize over their nearest neighbors, even in quasi electron-gas metals like sodium, and it is only in the decay rate of the probability distribution where conductors and insulators can be distinguished.

PI3K inhibition by BKM120 results in anti-proliferative effects on corticotroph tumor cells.

PURPOSE: Cushing's disease is associated with significant morbidity; thus, additional tumor-directed drugs with the potential to exert antineoplastic effects on corticotroph adenoma cells are desired. The phosphoinositide-3-kinase (PI3K)/protein kinase B (AKT) pathway, which plays regulatory role in cell survival and proliferation, is activated in pituitary adenomas. The present study evaluated the effects of BKM120 (Buparlisib), an oral PI3K inhibitor, on cell viability, apoptosis, cell cycle phase distribution, and ACTH production in mouse corticotroph tumor cells. METHODS: AtT-20/D16v-F2 mouse pituitary corticotroph tumor cells were treated with increasing concentrations of BKM120 or vehicle. Cell viability was measured using an MTS-based assay. Apoptosis was evaluated by Annexin V staining. Cell cycle analysis was performed by propidium iodide DNA staining and flow cytometry. Gene expression of cell cycle regulators (Cdkn1b, Ccnd1, Ccne1, Cdk2, Cdk4, Myc, and Rb1) was assessed by qPCR. Protein expression of p27, total and phosphorylated Akt was assessed by Western blot. ACTH levels were measured in the culture supernatants by chemiluminescent immunometric assay. RESULTS: Treatment with BKM120 decreased AtT-20/D16v-F2 cell viability, induced a G0/G1 cell cycle arrest, reduced the phosphorylation of Akt at Serine 473, and increased p27 expression. Furthermore, BKM120 treatment diminished ACTH levels in the cell culture supernatants. CONCLUSION: In vitro inhibition of PI3K/AKT pathway by BKM120 resulted in anti-proliferative effects on corticotroph tumor cells, decreasing cell viability and ACTH production. These encouraging findings shape the path for further experiments with the inhibition of PI3K/AKT pathway in Cushing's disease.

Quantification of bone marrow edema by MRI of the sacroiliac joints in patients diagnosed with axial spondyloarthritis: results from the ESPeranza cohort.

OBJECTIVE: To evaluate whether the quantification of bone marrow edema (BMO) of the sacroiliac (SI) joints by magnetic resonance imaging (MRI) improves capacity for axial spondyloarthritis (axSpA) classification in comparison with the assessment of sacroiliitis by Assessment of SpondyloArthritis international Society (ASAS) classification criteria. METHOD: This prospective study from the ESPeranza cohort involved 66 subjects with an available MRI of the SI joints at baseline. This subgroup includes patients with axSpA (n = 28), peripheral spondyloarthritis (n = 10), and other diagnoses that were not spondyloarthritis (n = 28). Measures of diagnostic usefulness [area under the curve (AUC), sensitivity, specificity, Youden's J statistic, positive and negative likelihood ratios (LR+ and LR-)] were calculated for MRI of the SI joints according to ASAS criteria and for MRI quantified by means of SCAISS (Spanish tool for semi-automatic quantification of sacroiliac inflammation by MRI in spondyloarthritis). This analysis was stratified in patients who were human leucocyte antigen (HLA)-B27 positive and negative. RESULTS: The AUC value with BMO quantification was 0.919 [95% confidence interval (CI) 0.799-1] for HLA-B27-positive patients and 0.884 (95% CI 0.764-1) for HLA-B27-negative patients. A SCAISS cut-off point of 80 units obtained a specificity of 94.4% and LR+ 7.5, while assessment by ASAS criteria showed a specificity value of 90% and LR+ 6.4. CONCLUSION: For patients with suspected axSpA, quantification of BMO improves the predictive capacity of MRI of the SI joints, for both HLA-B27-positive and HLA-B27-negative patients. Axial spondyloarthritis (axSpA) has a dramatic impact on physical function and quality of life (1). Despite its significant impact, patients with axSpA are normally diagnosed several years after presenting symptoms (2). In this respect, magnetic resonance imaging (MRI) of the sacroiliac (SI) joints has gained significance over the past decade, particularly in the early stages of the disease. Nowadays, imaging tests and human leucocyte antigen (HLA)-B27 testing are among the most important diagnostic procedures for patients with suspected axSpA.

Selective portal embolization combined with chemotherapy treatment in non-resectable liver tumors reduces tumor volume and generates contralateral compensating hypertrophy allowing for a full resection while avoiding liver transplantation. / La embolización portal selectiva coadyuvante al tratamiento quimioterápico en tumores hepáticos no resecables produce una reducción tumoral e hipertrofia compensadora contralateral que permite una resección completa evitando el trasplante hepático.

INTRODUCTION: Non-resectable liver tumors are one of the most frequent indications of pediatric liver transplantation. However, the usefulness of interventional techniques is still to be exploited. This is the case of a patient with a non-resectable liver sarcoma proposed for liver transplantation, which could be avoided as the tumor was fully resected following selective portal embolization combined with chemotherapy treatment. CLINICAL CASE: The patient was a 10-year-old female with a large hepatic mass compatible with undifferentiated PRETEXT III sarcoma treated according to the EpSSG RMS2005 protocol for high-risk tumors, but without achieving any reduction in volume. Given the risk of developing a small-for-size syndrome following a potential resection, a right portal embolization was performed in order to induce left hemi-liver hypertrophy. No response was observed after two months, so the patient was included on the liver transplantation list. However, one month later, a significant reduction in mass volume was noted at a control CT-scan, which meant the tumor could be resected while avoiding transplantation. The one-year follow-up was uneventful. DISCUSSSION: Interventional techniques should be considered as the main therapeutic option in non-resectable liver tumors, since they could potentially avoid transplantation in selected patients.

INTRODUCCION: Los tumores hepáticos irresecables figuran entre las indicaciones más frecuentes del trasplante hepático pediátrico. Sin embargo, las técnicas intervencionistas suponen un campo terapéutico con utilidades aún por explotar. Presentamos el caso de una paciente con un sarcoma hepático irresecable propuesta para trasplante hepático, que pudo evitarlo al ser completamente resecado tras realizar una embolización portal selectiva coadyuvante al tratamiento quimioterápico. CASO CLINICO: Paciente mujer de 10 años con masa hepática de gran tamaño compatible con sarcoma indiferenciado PRETEXT III tratado según el protocolo EpSSG RMS2005 para tumores de alto riesgo sin conseguir reducción del mismo. Debido al riesgo de desarrollar un síndrome small-for-size tras una eventual resección, se llevó a cabo una embolización portal derecha para inducir la hipertrofia del hemi-hígado izquierdo. Tras dos meses no se evidenció respuesta alguna, por lo que la paciente fue incluida en lista de trasplante hepático. Sin embargo, un mes después se observó una clara disminución de la masa en un TC de control y la resección pudo realizarse con éxito evitando así el trasplante. Tras un año de seguimiento, la paciente no presentó ningún evento clínico de interés. DISCUSION: Las técnicas intervencionistas deben ser consideradas como una opción terapéutica en tumores hepáticos irresecables, ya que podrían evitar el trasplante en pacientes seleccionados.

Measurement of the Fluctuations in the Number of Muons in Extensive Air Showers with the Pierre Auger Observatory.

We present the first measurement of the fluctuations in the number of muons in extensive air showers produced by ultrahigh energy cosmic rays. We find that the measured fluctuations are in good agreement with predictions from air shower simulations. This observation provides new insights into the origin of the previously reported deficit of muons in air shower simulations and constrains models of hadronic interactions at ultrahigh energies. Our measurement is compatible with the muon deficit originating from small deviations in the predictions from hadronic interaction models of particle production that accumulate as the showers develop.

La embolización portal selectiva coadyuvante al tratamiento quimioterápico en tumores hepáticos no resecables produce una reducción tumoral e hipertrofia compensadora contralateral que permite una resección completa evitando el trasplante hepático / Selective portal embolization combined with chemotherapy treatment in non-resectable liver tumors reduces tumor volume and generates contralateral compensating hypertrophy allowing for a full resection while avoiding liver transplantation

Introducción: Los tumores hepáticos irresecables figuran entrelas indicaciones más frecuentes del trasplante hepático pediátrico. Sinembargo, las técnicas intervencionistas suponen un campo terapéuticocon utilidades aún por explotar. Presentamos el caso de una pacientecon un sarcoma hepático irresecable propuesta para trasplante hepático,que pudo evitarlo al ser completamente resecado tras realizar una embolización portal selectiva coadyuvante al tratamiento quimioterápico. Caso clínico: Paciente mujer de 10 años con masa hepática de grantamaño compatible con sarcoma indiferenciado PRETEXT III tratadosegún el protocolo EpSSG RMS2005 para tumores de alto riesgo, sinconseguir reducción del mismo. Debido al riesgo de desarrollar un síndrome small-for-size tras una eventual resección, se llevó a cabo unaembolización portal derecha para inducir la hipertrofia del hemi-hígadoizquierdo. Tras dos meses no se evidenció respuesta alguna, por lo quela paciente fue incluida en lista de trasplante hepático. Sin embargo,un mes después se observó una clara disminución de la masa en unTC de control y la resección pudo realizarse con éxito evitando así eltrasplante. Tras un año de seguimiento, la paciente no presentó ningúnevento clínico de interés.Discusión: Las técnicas intervencionistas deben ser consideradascomo una opción terapéutica en tumores hepáticos irresecables, ya quepodrían evitar el trasplante en pacientes seleccionados.(AU)

Introduction: Non-resectable liver tumors are one of the most frequent indications of pediatric liver transplantation. However, the usefulnessof interventional techniques is still to be exploited. This is the case of apatient with a non-resectable liver sarcoma proposed for liver transplantation, which could be avoided as the tumor was fully resected followingselective portal embolization combined with chemotherapy treatment. Clinical case: The patient was a 10-year-old female with a largehepatic mass compatible with undifferentiated PRETEXT III sarcomatreated according to the EpSSG RMS2005 protocol for high-risk tumors,but without achieving any reduction in volume. Given the risk of developing a small-for-size syndrome following a potential resection, a rightportal embolization was performed in order to induce left hemi-liverhypertrophy. No response was observed after two months, so the patientwas included on the liver transplantation list. However, one month later,a significant reduction in mass volume was noted at a control CT-scan,which meant the tumor could be resected while avoiding transplantation.The one-year follow-up was uneventful. Discussion: Interventional techniques should be considered as themain therapeutic option in non-resectable liver tumors, since they couldpotentially avoid transplantation in selected patients.(AU)

The posterior insular cortex is necessary for the consolidation of tone fear conditioning.

The insular cortex (IC) is notably implicated in emotional and cognitive processing; however, little is known regarding to what extent its two main subregions play functionally distinct roles on memory consolidation of conditioned fear tasks. Here we verified the effects of temporary functional inactivation of the anterior (aIC) and posterior IC (pIC) on contextual and tone fear memory. Rats received post-training bilateral infusions of the GABAA receptor agonist muscimol into either the aIC or pIC and were tested 48 and 72 h after the delay tone fear conditioning session to assess the background contextual (CFC) and tone (TFC) fear conditioning, respectively. Inactivation of the aIC during memory consolidation did not affect fear memory for CFC or TFC. On the other hand, post-training inactivation of the pIC impaired TFC but not CFC. Our findings indicate that the pIC is a necessary part of the neural circuitry related to the consolidation of cued-fear memories.

Transcriptome of iPSC-derived neuronal cells reveals a module of co-expressed genes consistently associated with autism spectrum disorder.

Evaluation of expression profile in autism spectrum disorder (ASD) patients is an important approach to understand possible similar functional consequences that may underlie disease pathophysiology regardless of its genetic heterogeneity. Induced pluripotent stem cell (iPSC)-derived neuronal models have been useful to explore this question, but larger cohorts and different ASD endophenotypes still need to be investigated. Moreover, whether changes seen in this in vitro model reflect previous findings in ASD postmortem brains and how consistent they are across the studies remain underexplored questions. We examined the transcriptome of iPSC-derived neuronal cells from a normocephalic ASD cohort composed mostly of high-functioning individuals and from non-ASD individuals. ASD patients presented expression dysregulation of a module of co-expressed genes involved in protein synthesis in neuronal progenitor cells (NPC), and a module of genes related to synapse/neurotransmission and a module related to translation in neurons. Proteomic analysis in NPC revealed potential molecular links between the modules dysregulated in NPC and in neurons. Remarkably, the comparison of our results to a series of transcriptome studies revealed that the module related to synapse has been consistently found as upregulated in iPSC-derived neurons-which has an expression profile more closely related to fetal brain-while downregulated in postmortem brain tissue, indicating a reliable association of this network to the disease and suggesting that its dysregulation might occur in different directions across development in ASD individuals. Therefore, the expression pattern of this network might be used as biomarker for ASD and should be experimentally explored as a therapeutic target.

Challenges for Adoption of Integrated Pest Management (IPM): the Soybean Example.

Soybean is considered one of today's most important crops. Planted on millions of hectares worldwide, the management of soybean pests usually requires large amounts of chemicals. However, a key component to meet the increasing demand for food due to the rapidly growing global population is protecting crops from pests while maintaining environmental quality through ecologically and economically sound integrated pest management (IPM) practices. Not only can IPM result in more profitable agriculture due to the reduction of pest control costs but also assures equitable, secure, sufficient, and stable flows of both food and ecosystem services. Despite those ecological and economic benefits, the vast areas of cultivated soybean as well as the convenience of spraying insecticides are encouraging the adoption of prophylactic pest control as a relatively inexpensive safeguard compared to IPM practices. Thus, in this forum, we discuss the reasons for soybean IPM not reaching its potential. We give examples of how we can revive this once successful pest management program with a focus on experiences in Brazil and the USA. We analyze IPM case studies to illustrate the need for growers to have easy and fast access to IPM information on its medium- and long-term benefits. Overall, this forum highlights the importance of IPM for agricultural sustainability including ecological and financial benefits.

Features of the Energy Spectrum of Cosmic Rays above 2.5×10

We report a measurement of the energy spectrum of cosmic rays above 2.5×10^{18} eV based on 215 030 events. New results are presented: at about 1.3×10^{19} eV, the spectral index changes from 2.51±0.03(stat)±0.05(syst) to 3.05±0.05(stat)±0.10(syst), evolving to 5.1±0.3(stat)±0.1(syst) beyond 5×10^{19} eV, while no significant dependence of spectral features on the declination is seen in the accessible range. These features of the spectrum can be reproduced in models with energy-dependent mass composition. The energy density in cosmic rays above 5×10^{18} eV is [5.66±0.03(stat)±1.40(syst)]×10^{53} erg Mpc^{-3}.

[Sleep and academic performance in university students: a systematic review]. / Sueño y rendimiento académico en estudiantes universitarios: revisión sistemática.

INTRODUCTION: University students tend to suffer from problems of sleep regularity, quantity and quality, which can affect their academic performance. These problems are related to changes typical of the phase of the life cycle in which they find themselves due to maturational, psychosocial development (associated with the processes of individuation and socialisation) and academic factors. The study of the relationship between sleep and academic performance in university students is an area of research of growing interest, which has started to be studied over the last two decades. AIM: To conduct a systematic review of the existing literature on the relationship between sleep and academic performance in university students. SUBJECTS AND METHODS: The articles included in the PubMed database were selected, following the PRISMA guidelines. Studies evaluating samples of subjects with an average age between 18 and 26 years, published in English or Spanish during the period 2000-2019 were included. Subsequently, the quality of the selected articles was evaluated according to the STROBE standard. RESULTS: Thirty studies were identified, which were grouped according to different aspects of sleep: drowsiness, duration, experience of total sleep deprivation, sleep quality, chronotype, regularity and sleep disorders. CONCLUSION: The results of these studies suggest that inadequate sleep has a negative effect on the academic performance of university students.

TITLE: Sueño y rendimiento académico en estudiantes universitarios: revisión sistemática.Introducción. Los estudiantes universitarios tienden a padecer problemas de regularidad, cantidad y calidad de sueño, que pueden afectar a su rendimiento académico. Estos problemas se relacionan con cambios propios de la fase del ciclo vital en la que se encuentran debido a diversos factores: madurativos, del desarrollo psicosocial (asociados con los procesos de individuación y socialización) y académicos. El estudio de la relación entre el sueño y el rendimiento académico en estudiantes universitarios es un área de investigación de interés creciente, que ha empezado a ser objeto de estudio en las últimas dos décadas. Objetivo. Revisión sistemática de la bibliografía existente sobre la relación del sueño y el rendimiento académico en los estudiantes universitarios. Sujetos y métodos. Se seleccionaron los artículos recogidos en la base de datos PubMed, siguiendo las directrices PRISMA. Se incluyeron los estudios que valoraban muestras de sujetos con una edad media entre 18 y 26 años, publicados en inglés o castellano, durante el período 2000-2019. Posteriormente, se evaluó la calidad de los artículos seleccionados siguiendo la normativa STROBE. Resultados. Se identificaron 30 estudios, que fueron agrupados según distintos aspectos del sueño: somnolencia, duración, experiencia de privación total de sueño, calidad de sueño, cronotipo, regularidad y trastornos del sueño. Conclusión. Los resultados de estos estudios sugieren que un sueño inadecuado afecta negativamente al rendimiento académico de los estudiantes universitarios.

Evaluation of water quality in fee-fishing ponds located in Guarapirangas sub basin, Upper Tietê River basin, São Paulo State / Avaliação da qualidade da água de pesqueiros localizados na Sub-Bacia Guarapiranga, Alto Tietê, SP

Abstract This study intended to characterize the fee-fishing ponds located in Guarapiranga's sub-basin both in terms of structure and environmental conditions. The studied region was mapped and 15 out of 24 georeferenced fee-fishing ponds had their owners interviewed through semi-structured questionnaires. In addition to that, samples were collected from the seven fee-fishing ponds closest to the reservoir throughout a seasonal cycle divided in four sample collections carried out between November 2013 and August 2014, aiming at measuring the following variables in situ: water flow rates, pH, turbidity, electrical conductivity and dissolved oxygen concentration in affluents and effluents. Other samples were taken in order to assess total phosphorus (TP) and total nitrogen (TN) concentrations. Our results show a decrease in dissolved oxygen concentration along with an increase in TP and TN concentration in effluents, as compared to affluents. TP e TN concentrations exceeded the permitted values established by CONAMA 357/2005 - Class II resolution in all effluents at least during part of the year. High nutrient levels were observed in affluents, condition with which basins that have been affected by population growth are commonly met. It was verified, by interviewing the owners regarding venture management and by analyzing the collected samples, that there is significant correlation between the daily feeding and the TP and TN levels (p=0.021 and p=0.045, respectively), with the ponds where feeding is more intense having showed the highest nutrient levels in their effluents. The results highlight the importance of mitigation measures such as educating the owners on proper water management, the installation of pond aerators in conjunction with tanks the filters of which shall be composed of aquatic macrophytes in their effluents, as well as awareness campaigns aiming to reduce the usage of dough by fishermen in order to minimize detrimental impacts on Guarapiranga's sub-basin.

Resumo Este estudo objetivou caracterizar, em termos estruturais e ambientais pesqueiros localizados na sub-bacia da Guarapiranga. A região de estudo foi mapeada, e do total de 24 pesque-pague georreferenciados, 15 foram entrevistados com os proprietários através de questionários semi-estruturados e, nos sete pesque-pagues com tributários mais próximos da represa, foram coletadas amostras de água em um ciclo sazonal divididas em quatro coletas entre novembro de 2013 a agosto de 2014. Foram medidos in situ: vazão, pH, turbidez, condutividade elétrica e oxigênio dissolvido nos afluentes e efluentes, e também foram coletadas amostras de água para determinação da concentração de fósforo total (PT) e nitrogênio total (NT). Os resultados mostraram que há uma diminuição nas concentrações de oxigênio dissolvido e aumento nas concentrações de PT e NT nos efluentes em relação aos afluentes. Os efluentes apresentaram valores de PT e NT acima dos limites permitidos pela resolução CONAMA 357/2005 - Classe II, ao menos em um período do ano. Também foram identificados afluentes com cargas elevadas de nutrientes, característica de bacias impactadas pelo adensamento populacional. Através do questionário aplicado aos proprietários sobre o manejo dos empreendimentos e pelas análises de água verificou-se que houve correlação significativa entre o arraçoamento diário e as cargas de PT e de NT (p=0,021 e p=0,045, respectivamente), sendo que nos locais onde o arraçoamento foi mais intenso, a carga de nutrientes nos efluentes foi maior. Os resultados evidenciam a importância de medidas mitigadoras como orientações aos proprietários para o manejo adequado dos lagos, projetos de educação ambiental com os usuários para diminuir do uso de ceva para a captura dos peixes, além da instalação de aeradores artificiais nos lagos e tanques com filtros compostos de macrófitas aquáticas nos seus efluentes, minimizando os impactos na sub-bacia do Guarapiranga.

Pilonidal sinus in pediatric age: primary vs. secondary closure. / Sinus pilonidal en edad pediátrica. Cierre primario versus cierre por segunda intención.

INTRODUCTION: Pilonidal sinus (PS) is a highly frequent condition in teenagers. There is no consensus on which type of closure should be carried out following surgical removal. Our objective is to compare primary closure (PC) results with secondary closure (SC) or deferred closure results. MATERIALS AND METHODS: Patients undergoing surgery for PS between 2013 and 2018 were studied and classified according to the type of closure. Presence of infection at removal, recurrence rate, pre- and postoperative antibiotic treat-ment, number of previous drainages, and sinus size were analyzed. RESULTS: Of the 57 patients (29 of whom women), 29 were treated using PC and 28 using SC. Mean age was 14±1 years in the PC group, and 16±1 years in the SC group. PC patients presented a postoperative partial dehiscence rate of 26%. No statistically significant differences were found between groups regarding the presence of infection at surgery, recurrence rate, postoperative antibiotic treat-ment, number of previous drainages, and sinus size (p>0.05). The SC group re-quired more postoperative dressings [4 (0-6) vs. 8 (2-11) (p<0.01)] and longer time to healing [60 days (9-240) vs. 98 days (30-450) (p<0.01)]. CONCLUSIONS: 1 out of 4 PS patients with PC presents postoperative partial dehiscence. However, PC involves fewer subsequent dressings and shorter heal-ing times as compared to SC.

INTRODUCCION: El sinus pilonidal (SP) es muy frecuente en adolescentes. Tras la escisión quirúrgica no existe consenso sobre qué tipo de cierre es el más idóneo. Nuestro objetivo es comparar resultados del cierre primario (CP) frente al cierre por segunda intención o diferido (CD). MATERIAL Y METODOS: Estudiamos los pacientes intervenidos de SP desde 2013-2018, clasificándolos según el tipo de cierre. Se analizaron la presencia de infección en el momento de la escisión, la tasa de recidiva, el tratamiento antibiótico pre/postoperatorio, el número de drenajes previos y el tamaño del sinus. RESULTADOS: De los 57 pacientes (29 mujeres), 29 fueron tratados mediante CP y 28 con CD. Su edad media fue de 14 años ± 1a en el grupo CP y 16 años ± 1a en el CD. Los pacientes con CP presentaron una tasa de dehiscencia parcial postoperatoria del 26%. No encontramos diferencias significativas en la presencia de infección en el momento de la intervención, en la tasa de recidiva entre ambos grupos, el tratamiento antibiótico postoperatorio, el número de drenajes previos o el tamaño del sinus (p>0,05). El grupo de CD requirió mayor número de curas postoperatorias [4 (0-6) vs. 8 (2-11) (p<0,01)] y mayor tiempo hasta la curación [60 días (9-240) vs. 98 días (30-450) (p<0,01)]. CONCLUSIONES: Uno de cada 4 pacientes con cierre primario del SP presenta dehiscencia parcial postoperatoria. A pesar de ello las curas posteriores y el tiempo de curación son inferiores comparados con el cierre por segunda intención.

Sinus pilonidal en edad pediátrica. Cierre primario versus cierre por segunda intención / Pilonidal sinus in pediatric age: primary vs. secondary closure

Introducción: El sinus pilonidal (SP) es muy frecuente en adolescentes. Tras la escisión quirúrgica no existe consenso sobre qué tipo de cierre es el más idóneo. Nuestro objetivo es comparar resultados del cierre primario (CP) frente al cierre por segunda intención o diferido (CD). Material y métodos: Estudiamos los pacientes intervenidos de SP desde 2013-2018, clasificándolos según el tipo de cierre. Se analizaron la presencia de infección en el momento de la escisión, la tasa de recidiva, el tratamiento antibiótico pre/postoperatorio, el número de drenajes previos y el tamaño del sinus. Resultados: De los 57 pacientes (29 mujeres), 29 fueron tratados mediante CP y 28 con CD. Su edad media fue de 14 años ± 1a en el grupo CP y 16 años ± 1a en el CD. Los pacientes con CP presentaron una tasa de dehiscencia parcial postoperatoria del 26%. No encontramos diferencias significativas en la presencia de infección en el momento de la intervención, en la tasa de recidiva entre ambos grupos, el tratamiento antibiótico postoperatorio, el número de drenajes previos o el tamaño del sinus (p > 0,05). El grupo de CD requirió mayor número de curas postoperatorias [4 (0-6) vs. 8 (2-11) (p < 0,01)] y mayor tiempo hasta la curación [60 días (9-240) vs. 98 días (30-450) (p < 0,01)]. Conclusiones: Uno de cada 4 pacientes con cierre primario del SP presenta dehiscencia parcial postoperatoria. A pesar de ello las curas posteriores y el tiempo de curación son inferiores comparados con el cierre por segunda intención

Introduction: Pilonidal sinus (PS) is a highly frequent condition in teenagers. There is no consensus on which type of closure should be carried out following surgical removal. Our objective is to compare primary closure (PC) results with secondary closure (SC) or deferred closure results. Materials and methods: Patients undergoing surgery for PS be-tween 2013 and 2018 were studied and classified according to the type of closure. Presence of infection at removal, recurrence rate, pre- and postoperative antibiotic treatment, number of previous drainages, and sinus size were analyzed. Results: Of the 57 patients (29 of whom women), 29 were treated using PC and 28 using SC. Mean age was 14 ± 1 years in the PC group, and 16 ± 1 years in the SC group. PC patients presented a postoperative partial dehiscence rate of 26%. No statistically significant differences were found between groups regarding the presence of infection at sur-gery, recurrence rate, postoperative antibiotic treat-ment, number of previous drainages, and sinus size (p > 0.05). The SC group re-quired more postoperative dressings [4 (0-6) vs. 8 (2-11) (p < 0.01)] and longer time to healing [60 days (9-240) vs. 98 days (30-450) (p < 0.01)].Conclusions. 1 out of 4 PS patients with PC presents postoperative partial dehiscence. However, PC involves fewer subsequent dressings and shorter heal-ing times as compared to SC