Diferencias de género en la titulación de fármacos de pacientes con insuficiencia cardiaca y fracción de eyección reducida del ensayo ETIFIC / Gender differences in drug titration among heart failure patients with reduced ejection fraction in the ETIFIC trial

Introducción y objetivos El tratamiento óptimo disminuye la mortalidad y hospitalizaciones por insuficiencia cardiaca (IC) en pacientes con IC y fracción de eyección reducida. En los ensayos clínicos las mujeres estuvieron infrarrepresentadas y no fueron evaluadas específicamente. Este estudio buscó comparar la seguridad y efectividad de titulación (ajuste de dosis) de fármacos en mujeres y varones. Métodos Estudio post hoc de género del ensayo aleatorizado multicéntrico ETIFIC. Se incluyeron pacientes hospitalizados con IC de novo y fracción de eyección reducida. Proceso estructurado de titulación en unidades de IC. Objetivo principal: la dosis relativa media de bloqueadores beta (% de la dosis objetivo) alcanzada por mujeres frente a varones. Objetivos secundarios: dosis relativas medias de otros fármacos de IC, eventos adversos y resultados clínicos a 6 meses. Resultados Se incluyeron 320 pacientes, 83 (25,93%) mujeres y 237 (74,06%) varones. (76 frente a 213 analizados). Media±desviación estándar de dosis relativa de bloqueadores beta mujeres frente a varones: 62,08±30,72% frente a 64,4±32,77%; diferencia −2,32%; IC95%, −10,58-5,94; p=0,580, antagonistas del receptor de mineralocorticoides 79,85±27,72% comparado con 67,29±31,43%; p=0,003, sin diferencias significativas en dosificación de otros fármacos. El análisis multivariante no encontró diferencias significativas. Mortalidad cardiovascular 1 (1,20%) frente a 3 (1,26%), p=1 y 0 hospitalizaciones por IC (0,00%) frente a 10 (4,22%), p=0,125. Conclusiones En un análisis post hoc del ensayo ETIFIC de titulación en IC no encontramos diferencias de género significativas en dosificación, mortalidad cardiovascular y hospitalizaciones por IC (AU)

Introduction and objectives Optimal medical therapy decreases mortality and heart failure (HF) hospitalizations in HF patients with reduced left ventricular ejection fraction. Women have been underrepresented in clinical trials and not specifically evaluated. This study aimed to compare the safety and effectiveness of drug titration in women vs men. Methods This post hoc gender study of the ETIFIC multicenter randomized trial included hospitalized patients with new-onset HF with reduced ejection fraction and New York Heart Association II-III and no contraindications to beta-blockers. A structured 4-month titration process was implemented in HF clinics. The primary endpoint was the mean relative dose (% of target dose) of beta-blockers achieved by women vs men. Secondary endpoints included the mean relative doses of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and mineralocorticoid receptor antagonists, adverse events, and other clinical outcomes at 6 months. Results A total of 320 patients were included, 83 (25.93%) women and 237 (74.06%) men (76 vs 213 analyzed). The mean±standard deviation of the relative doses achieved by women vs men were as follows: beta-blockers 62.08%±30.72% vs 64.4%±32.77%, with a difference of−2.32% (95%CI,−10.58-5.94), P = .580; and mineralocorticoid receptor antagonists 79.85%±27.72% vs 67.29%±31.43%, P =.003. No other differences in drug dosage were found. Multivariate analysis showed nonsignificant differences. CV mortality was 1 (1.20%) vs 3 (1.26%), P=1, and HF hospitalizations 0 (0.00%) vs 10 (4.22%), P=.125. Conclusions In a post hoc analysis from the HF-titration ETIFIC trial, we found nonsignificant gender differences in drug dosage, cardiovascular mortality, and HF hospitalizations (AU)

Reporte de caso: manejo multidisciplinario en gestante con embarazo de 31 semanas y COVID-19 positivo con evolución grave / Case report: multidisciplinary management in case of 31 weeks pregnant woman and COVID 19 infection with severe disease presentation

INTRODUCCIÓN: En diciembre de 2019 se reporta un brote de neumonía atípica causada por un nuevo coronavirus: SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2), cuya enfermedad se denomina COVID-19 (Coronavirus Disease 2019). Desde entonces su distribución se ha ampliado mundialmente causando una emergencia en los sistemas de salud. MÉTODO: Corresponde al reporte de caso clínico. Este estudio es descriptivo y se basa en el manejo realizado a paciente embarazada con COVID-19 confirmado. Esta publicación cuenta con la autorización del comité de ética local para la revisión de ficha clínica. CASO: Mujer de 40 años con un embarazo de 31 semanas, se le diagnostica COVID-19 tras contacto estrecho con caso confirmado. Evoluciona con disnea y por posibilidad de interrupción del embarazo se traslada a centro de mayor complejidad. Allí se pesquisa compromiso de función pulmonar, uso de musculatura accesoria y alteración sensorial, requiriendo oxigenoterapia. Se evalúa interdisciplinariamente decidiendo intubar y realizando manejo en unidad de cuidados intensivos (UCI). Se realiza cesárea de urgencia a las 31+4 semanas debiendo realizarse histerectomía total por inercia uterina. Tras el procedimiento evoluciona tórpidamente con deterioro de función pulmonar, describiéndose un pronóstico catastrófico con probabilidad de fallecer por insuficiencia respiratoria. Un mes después despierta con una mejoría en su función pulmonar, sin otra falla orgánica. Actualmente se encuentra en buenas condiciones y es tratada multidisciplinariamente para lograr una rehabilitación integral. DISCUSIÓN: En epidemias pasadas, las embarazadas mostraron altas tasas de letalidad y riesgo de ingreso a UCI. Basados en una revisión de reportes de casos, parece ser que COVID-19 durante el embarazo se asocia a morbilidad materna severa, riesgo que aumenta en mujeres con comorbilidades, lo cual hace cuestionarnos si la infección por COVID-19 intensifica el riesgo materno o estos casos ya eran embarazos de riesgo. Se necesitan futuras investigaciones al respecto.

INTRODUCTION: The coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, was first reported in december 2019 in China as an atypipical pneumonia. Since then its distribution has globally expanded causing a public health emergency. METHOD: Corresponds to a case report. A descriptive study about the management of a pregnant woman whith COVID-19. CASE: A 40 year old pregnant woman, 31 weeks gestational age, was admitted with a diagnosis of COVID-19. She developed dyspnea and preterm birth risk that needed a more complex hospital level. Thereafter, the patient developed respiratory distress, use of accessory breathing muscles and neurological alteration, requiring oxygen therapy. An interdisciplinary medical team evaluation decided to manage her condition at intensive care unit (ICU). Cesarean delivery was performed at 31+4 weeks. After the procedure, the pulmonary function declined to a life threatening condition. A month later, the patient woke up with improved pulmonary function, without any organ failure. Currently the patient is in a good general condition with a multidisciplinary rehabilitation treatment ongoing. DISCUSSION: In previous epidemic outbrakes, pregnant women presented high fatality rates and intensive care tratment risk. Based on a case report review, COVID-19 in pregnancy is associated with severe maternal morbidity, specially in women with associated comorbidities. This situation raises the question whether the COVID-19 infection intensifies the maternal risk or whether these cases were already a high risk pregnancies. Additional studies are needed to answer this issue.

A little garbage in, lots of garbage out: Assessing the impact of careless responding in personality survey data.

In self-report surveys, it is common that some individuals do not pay enough attention and effort to give valid responses. Our aim was to investigate the extent to which careless and insufficient effort responding contributes to the biasing of data. We performed analyses of dimensionality, internal structure, and data reliability of four personality scales (extroversion, conscientiousness, stability, and dispositional optimism) in two independent samples. In order to identify careless/insufficient effort (C/IE) respondents, we used a factor mixture model (FMM) designed to detect inconsistencies of response to items with different semantic polarity. The FMM identified between 4.4% and 10% of C/IE cases, depending on the scale and the sample examined. In the complete samples, all the theoretical models obtained an unacceptable fit, forcing the rejection of the starting hypothesis and making additional wording factors necessary. In the clean samples, all the theoretical models fitted satisfactorily, and the wording factors practically disappeared. Trait estimates in the clean samples were between 4.5% and 11.8% more accurate than in the complete samples. These results show that a limited amount of C/IE data can lead to a drastic deterioration in the fit of the theoretical model, produce large amounts of spurious variance, raise serious doubts about the dimensionality and internal structure of the data, and reduce the reliability with which the trait scores of all surveyed are estimated. Identifying and filtering C/IE responses is necessary to ensure the validity of research results.

Prevalence of ankylosing spondylitis in Spain: EPISER2016 Study.

Objective: The aim of this study was to estimate the prevalence of ankylosing spondylitis (AS) in Spain.Method: This is a cross-sectional, population-based study of people aged 20 years or older in Spain. Randomly selected individuals were contacted by telephone and rheumatic disease screening was performed. If the first screening was positive, medical records were then reviewed and/or a telephone questionnaire was conducted by a rheumatologist, followed by an appointment if necessary. Cases had to fulfil the modified New York (mNY) criteria.Results: In total, 4916 individuals were included, of whom 355 had a positive screening result for AS. Of these, 11 were classified as AS. An additional individual who reported a prior diagnosis of rheumatoid arthritis had a diagnosis of AS confirmed on review of the medical records. Estimated prevalence was 0.26% (95% CI 0.14-0.49).Conclusion: EPISER2016 is the first population-based study to estimate the prevalence of AS in Spain, which has been estimated as being similar to that in other European countries.

[Impact of resistive therapy on gait parameters in children with cerebral palsy: systematic review and meta-analysis]. / Impacto de la terapia resistida sobre los parametros de la marcha en niños con paralisis cerebral: revision sistematica y metaanalisis.

INTRODUCTION: Cerebral palsy is one of the main causes of disability in childhood. Resistive therapy has proved to be beneficial in increasing strength and motor function in these patients, but its impact on gait is not yet clear. AIM: To analyse the impact of resistive therapy on improving gait through a systematic review and meta-analysis. PATIENTS AND METHODS: A search was conducted in Medline, ISI Web of Knowledge and PEDro for clinical trials in which resistive therapy was used and at least one gait parameter was assessed. RESULTS: Nine controlled studies and one single-arm study were identified. In terms of pre-post difference, the overall intragroup effect was in favour of the intervention, with null heterogeneity (standardised mean difference: 0.32; 95% CI: 0.19-0.44). The standardised mean differences were also positive as they restricted each of the gait parameters analysed: 0.36, 0.35 and 0.22 for step cadence, gait speed and step length, respectively. As regards the difference between groups, the results showed high heterogeneity, and the mean difference was also favourable, especially for speed (7.3 cm/s; 95% CI: 2.67-11.92), cadence (5.66 steps; 95% CI: 1.86-9.46) and, to a lesser extent, step length (3.25 cm; 95% CI: -1.69 to 8.19). CONCLUSION: The results support the impact of resistive therapy on gait improvement, especially in terms of the gait speed and step cadence parameters.

TITLE: Impacto de la terapia resistida sobre los parametros de la marcha en niños con paralisis cerebral: revision sistematica y metaanalisis.Introduccion. La paralisis cerebral es una de las principales causas de discapacidad en la infancia. La terapia resistida ha demostrado beneficio en el aumento de la fuerza y la funcion motora de estos pacientes, pero su impacto en la marcha aun no esta claro. Objetivo. Analizar el impacto de la terapia resistida sobre la mejora en la marcha, mediante una revision sistematica y metaanalisis. Pacientes y metodos. Se realizo una busqueda en Medline, ISI Web of Knowledge y PEDro de ensayos clinicos en los que se intervino con terapia resistida y se evaluo al menos un parametro de marcha. Resultados. Se identificaron nueve estudios controlados y uno de un solo brazo. En cuanto a la diferencia pre-post, el efecto global intragrupo fue a favor de la intervencion, con una heterogeneidad nula (diferencia estandarizada de medias: 0,32; IC 95%: 0,19-0,44). Las diferencias estandarizadas de medias fueron asimismo positivas al restringir a cada uno de los parametros de marcha analizados: 0,36, 0,35 y 0,22 para la velocidad de la marcha, la cadencia del paso y la longitud del paso, respectivamente. En relacion con la diferencia entre grupos, los resultados mostraron una heterogeneidad elevada y la diferencia de medias tambien fue favorable, especialmente para la velocidad (7,3 cm/s; IC 95%: 2,67-11,92) y la cadencia (5,66 pasos; IC 95%: 1,86-9,46), y en menor medida para la longitud del paso (3,25 cm; IC 95%: -1,69 a 8,19). Conclusion. Los resultados apoyan el impacto de la terapia resistida en la mejora en la marcha, especialmente en cuanto a los parametros de velocidad de la marcha y cadencia del paso.

Cirugía funcional en tumores malignos subungueales. Serie de casos y revisión de la literatura / Functional Surgery for Malignant Subungual Tumors: A Case Series and Literature Review

ANTECEDENTES Y OBJETIVOS: El tratamiento clásico de los tumores malignos subungueales (TMSU), carcinoma epidermoide (CESU) y melanoma (MSU), es la amputación. La cirugía funcional del aparato ungueal (CFAU) puede preservar la función sin modificar el pronóstico. Presentamos nuestra serie de TMSU manejados con CFAU, describimos la técnica y revisamos sus indicaciones. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo de TMSU tratados con CFAU entre 2008 y 2017, con exéresis supraperióstica en bloque del aparato ungueal, margen a 5 mm, y cierre con injerto de piel total. RESULTADOS: Se trataron 11 TMSU, de los cuales 7 fueron MSU (4 in situ, espesor medio: 1,17mm; rango: 0-4mm) y 4 CESU (espesor medio: 3,4 mm; rango: 1,6-6 mm). Se realizó CFAU en 9 casos y 2 amputaciones en sendos MSU invasivos. El seguimiento medio fue 39 meses, con un rango de 12-96 meses. No hubo recidivas locales ni regionales. Solo un caso -una de las 2 amputaciones- tuvo metástasis (cerebrales) y muerte. La revisión de la literatura de CFAU en TMSU mostró 5 series (103 pacientes en total) con CESU y 14 series (243 pacientes en total) con MSU. El análisis de nuestros casos y de los casos publicados muestra muy escasas recurrencias locales (< 7%), y mejores resultados funcionales y estéticos frente a la amputación. CONCLUSIONES: La CFAU es de elección en CESU sin afectación ósea y MSU no invasivo o delgado (Breslow <1mm). Es factible en MSU de grosores intermedios siempre con detallado estudio histológico de márgenes que asegure una resección completa. Por el contrario, en CESU con afectación ósea, MSU muy grueso (>4mm) o recurrencias, la amputación debe ser habitualmente de elección

BACKGROUND AND OBJECTIVES: Amputation is the conventional treatment for malignant subungual tumors (MSUTs), namely, subungual squamous cell carcinoma (SUSCC) and subungual melanoma (SUM). Functional surgery consisting of wide local excision (WLE) of the nail unit can preserve function without modifying prognosis in such cases. We present a series of MSUTs treated with WLE of the nail unit, describe the technique, and review its indications. MATERIAL AND METHODS: Retrospective observational study of MSUTs treated with WLE of the nail unit between 2008 and 2017. The technique consisted of en bloc supraperiosteal excision of the nail unit with a margin of 5mm followed by repair with a full-thickness graft. RESULTS: Eleven MSUTs were treated in the study period: 7 SUMs (4 in situ; mean thickness, 1.17 mm; range, 0-4mm) and 4 SUSCCs (mean thickness, 3.4mm; range, 1.6-6 mm). WLE of the nail unit was performed in 9 patients and amputation in 2 patients with invasive SUM. Mean follow-up was 39 months (range, 12-96 months) and no local or regional recurrences were detected. One of the 2 patients who underwent amputation developed metastasis to the brain and died. In our review of the literature, we identified 5 series of patients with SUSCC treated with WLE of the nail unit (105 patients) and 14 series of patients with SUM (243 patients). Based on an analysis of these cases and ours, it would appear that WLE of the nail unit is associated with a very low rate of local recurrence (<7%) and offers better functional and cosmetic outcomes than amputation. CONCLUSIONS: WLE of the nail unit is the treatment of choice for SUSCC without bone involvement and for thin noninvasive SUM (Breslow depth <1mm). It is also feasible in intermediate-thickness SUMs when detailed histologic examination of the margins confirms complete resection. Amputation, by contrast, is the treatment of choice for SUSCCs with bone involvement, very thick SUMs (> 4 mm), and recurrent tumors

Facial expression recognition as a candidate marker for autism spectrum disorder: how frequent and severe are deficits?

Background: Impairments in social communication are a core feature of Autism Spectrum Disorder (ASD). Because the ability to infer other people's emotions from their facial expressions is critical for many aspects of social communication, deficits in expression recognition are a plausible candidate marker for ASD. However, previous studies on facial expression recognition produced mixed results, which may be due to differences in the sensitivity of the many tests used and/or the heterogeneity among individuals with ASD. To ascertain whether expression recognition may serve as a diagnostic marker (which distinguishes people with ASD from a comparison group) or a stratification marker (which helps to divide ASD into more homogeneous subgroups), a crucial first step is to move beyond identification of mean group differences and to better understand the frequency and severity of impairments. Methods: This study tested 46 individuals with ASD and 52 age- and IQ-matched typically developing (TD) participants on the Films Expression Task, which combines three key features of real-life expression recognition: naturalistic facial expressions, a broad range of simple and complex emotions, and short presentation time. Test-retest reliability was assessed in 28 individuals who did not participate in the main study and revealed acceptable reliability (ICC r = .74). Results: Case-control comparisons showed highly significant mean group differences for accuracy (p = 1.1 × 10- 10), with an effect size (Cohen's d = 1.6), more than twice as large as the mean effect size reported in a previous meta-analysis (Uljarevic and Hamilton, 2012, J Autism Dev Disord). The ASD group also had significantly increased mean reaction times overall (p = .00015, d = .83) and on correct trials (p = .0002, d = .78). However, whereas 63% of people with ASD showed severe deficits (they performed below two standard deviations of the TD mean, a small subgroup (15.3%) performed normally (within one standard deviation of the mean). Conclusion: These findings indicate that the majority of people with ASD have severe expression recognition deficits and that the Films Expression Test is a sensitive task for biomarker research in ASD. Future work is needed to establish whether ASD subgroups with and without expression recognition deficits differ from one another in terms of their symptom profile or neurobiological underpinnings.

Lead(ii) soaps: crystal structures, polymorphism, and solid and liquid mesophases.

The long-chain members of the lead(ii) alkanoate series or soaps, from octanoate to octadecanoate, have been thoroughly characterized by means of XRD, PDF analysis, DSC, FTIR, ssNMR and other techniques, in all their phases and mesophases. The crystal structures at room temperature of all of the members of the series are now solved, showing the existence of two polymorphic forms in the room temperature crystal phase, different to short and long-chain members. Only nonanoate and decanoate present both forms, and this polymorphism is proven to be monotropic. At higher temperature, these compounds present a solid mesophase, defined as rotator, a liquid crystal phase and a liquid phase, all of which have a similar local arrangement. Since some lead(ii) soaps appear as degradation compounds in oil paintings, the solved crystal structures of lead(ii) soaps can now be used as fingerprints for their detection using X-ray diffraction. Pair distribution function analysis on these compounds is very similar in the same phases and mesophases for the different members, showing the same short range order. This observation suggests that this technique could also be used in the detection of these compounds in disordered phases or in the initial stages of formation in paintings.

A comprehensive profiling of sulfatides in myelin from mouse brain using liquid chromatography coupled to high-resolution accurate tandem mass spectrometry.

Sulfatides are sulfoglycolipids found in the myelin sheath. The composition ratio of sulfatide molecular species changes with age, and it has also been associated with the pathogenesis of various human central nervous system diseases. However, profiling sulfatides in biological samples is difficult, due to the great variety of molecular species. In this work, a new, easy and reliable liquid chromatography-electrospray tandem mass spectrometry (LC-ESI(+)-MS/MS) method has been developed to profile sulfatide content in biological samples of myelin. The 'wrong-way-round' ionization effect has been described for this type of molecules for the first time, making it possible to correctly identify as many as 37 different sulfatides in mouse brain myelin samples, including molecules with different fatty acid chain lengths and varying degrees of unsaturation and hydroxylation. A chemometric analysis of their relative abundances showed that the main difference among individuals of different ages was the content of sulfatides with odd-numbered fatty acid chains, in addition to hydroxylated species.

Satisfaction with a therapeutic sleeve for arm lymphedema secondary to breast cancer treatment: Controlled crossover trial.

HIGHLIGHTS: Secondary lymphedema is a late iatrogenic side effect of breast cancer treatment.Despite multimodal decongestive therapy in their daily life breast cancer survivors with lymphedema have few alternatives but to use a compressive sleeve.Concerned with the well-known low compliance to the daily use of traditional sleeves, we conducted a comparative study to evaluate the subjective assessment of an innovative class 1 compression sleeve.We concluded that the PRADEX® sleeve, not being worse in its compressive efficacy, is much better with regard to patient comfort. ABSTRACT: Secondary arm lymphedema is a feared late iatrogenic side effect of breast cancer survivors with a negative impact on patient's self-image and quality of life. Its reported incidence is extremely variable, from 6% to 80%, as well as the effectiveness of the multimodal decongestive lymphedema therapy.In their daily life breast cancer survivors with lymphedema have few alternatives but to use a compressive sleeve. Concerned with the well-known low compliance to the daily use of traditional sleeves, we conducted a comparative study in a subgroup of our patients with lymphedema secondary to breast cancer treatment for the subjective assessment of PRADEX®, an innovative class 1 compression sleeve. Secondarily, we aimed to assess the non-inferiority of PRADEX® regarding subjective and objective measures of the severity of lymphedema.We studied 46 women with grade 1 secondary arm lymphedema, who used their usual sleeve and PRADEX® daily for 2 weeks each, in a crossover design.The new therapeutic sleeve was classified as having a better design and a better usability and comfort (more comfortable, thinner, fresher, softer, more flexible, comfortable, resistant to dirt and easier to dress and to wear). Women's subjective opinion about the severity of lymphedema favored their usual sleeve in detriment of PRADEX®, but this subjective feeling was contradicted by objective measurements of different perimeters of the arm at the beginning and at the end of the study.We concluded that the PRADEX® sleeve, not being worse in its compressive therapeutic efficacy, is much better with regard to patient comfort.

Impacto de una intervención en alimentación y nutrición en escolares / Impact of food and nutrition intervention on students in Santiago

Introducción: Las intervenciones a nivel escolar constituyen una de las estrategias más importantes para enfrentar la obesidad en la población infantil. Objetivo: Determinar los cambios en los patrones de alimentación y estado nutricional en una intervención de 2 años de duración en alimentación saludable y actividad física en escolares. Sujetos y Método: Se intervinieron durante 2 años a 2.527 estudiantes de primero a cuarto básico de escuelas básicas de las comunas de Santiago Centro, Estación Central y Peñalolén, en Alimentación-Nutrición y Actividad física. A cada apoderado se le realizó una Encuesta de Frecuencia de Alimentos y a los escolares una evaluación antropométrica al inicio y final de la intervención. Resultados: De 2.527 estudiantes intervenidos finalizaron 1.453. La prevalencia de obesidad disminuyó de un 23,4 a 20,1%. Los escolares obesos incrementaron de forma significativa el consumo de frutas (p < 0,05), pescado (p < 0,01) y leguminosas (p < 0,05) y redujeron el consumo de bebidas gaseosas (p < 0,01) y pasteles/ dulces/chocolates (p < 0,01). Conclusión: Los resultados de este estudio demuestran que la intervención en los colegios en alimentación saludable y actividad física, puede mejorar el estado nutricional en escolares con sobrepeso y obesidad e incrementar el consumo de alimentos saludables.

Introduction: School interventions are one of the most important strategies to combat obesity in children. Objective: To determine changes in eating patterns and nutritional status after an intervention of two years long that promoted healthy eating and physical activity in school children. Subjects and Method: 2,527 students, between first and fourth grade, were intervened for two years in the districts of Santiago Centro, Estacion Central and Peñalolen regarding Food, Nutrition and Physical Activity. Each parent underwent a Food Frequency Survey and the students were anthropometrically assessed at the beginning and at the end of the intervention. Results: 1,453 out of 2,527 completed the whole process. The prevalence of obesity decreased from 23.4 to 20.1%. Obese schoolchildren significantly increased fruit consumption (p < 0.05), fish (p < 0.01) and legumes ( p < 0.05 ) and reduced the consumption of soft drinks (p < 0.01) and cakes/candy/chocolates (p < 0.01). Conclusion: The results of this study demonstrate that interventions in schools on healthy eating and physical activity can improve the nutritional status of obese and overweighed children and increase healthy food consumption.

Sustratos electrohilados de poli(hidroxibutirato-co-hidroxihexanoato) con glicósidos para reparación de la lesión medular / Glycosides-bearing electrospun poly(hydroxybutyrate-co-hydroxyhexanoate) substrates for the repair of injured spinal cord

Objetivo: Obtención mediante electrohilado de fibras micro- y submicrométricas de poliésteres funcionalizadas con glicósidos que constituyen elementos estructurales de proteoglicanos, para su uso en la reparación del tejido medular. Material y métodos: Las fibras se prepararon a partir de disoluciones de poli(3-hidroxibutirato-co-3-hidroxihexanoato) con glicósidos sintéticos mediante electrohilado variando sistemáticamente las condiciones del proceso. La morfología de las fibras fue analizada mediante microscopía electrónica de barrido. Asimismo, se evaluó la estabilidad de la interacción entre el glicósido y la fibra en medio acuoso, y su toxicidad en cultivos de células neurales. Resultados: La morfología de las fibras obtenidas depende principalmente de los parámetros de la disolución. En medio acuoso, el glicósido sulfatado se liberó de las fibras más lentamente que el que no tenía dicho grupo funcional. La viabilidad de las células neurales no se vio afectada por los glicósidos. Conclusión: La preparación de microfibras alineadas de poliéster funcionalizadas con glicósidos es posible. La mayor parte del glicósido permanece retenido en las fibras sumergidas en agua después de varios días. El electrohilado es una técnica muy accesible y versátil para la fabricación de soportes en estrategias de terapia celular de lesiones medulares (AU)

Objective: Preparation of functionalized micro- and submicrofibers by electrospinning of polyesters with glycosides which are structural elements of proteoglycans, for application to the repair of spinal cord lesions. Material and methods: Solutions of poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) with synthetic glycosides were prepared varying systematically the processing conditions. Fiber morphology assessed by scanning electron microscopy. The stability of the interaction between the glycoside and the polymer fiber was evaluated in aqueous medium, and their toxicity in cultures of neural cells. Results: The fiber morphology was altered mainly by the solution parameters. In aqueous medium, the glycoside with a sulfate group was released from fibers at slower rate than the non-sulfated glycoside. The viability of neural cells was not affected by the glycosides. Conclusion: It is possible to fabricate aligned polyester micro fibers with glycosides. Most of the glycoside present in the fibers remains in the substrate after extraction in water for several days. Electrospinning is a very accessible and versatile technique for application to strategies of cellular therapy in spinal cord injuries (AU)

Microbial communities from different types of natural wastewater treatment systems: vertical and horizontal flow constructed wetlands and biofilters.

The prokaryotic microbial communities (Bacteria and Archaea) of three different systems operating in Denmark for the treatment of domestic wastewater (horizontal flow constructed wetlands (HFCW), vertical flow constructed wetlands (VFCW) and biofilters (BF)) was analysed using endpoint PCR followed by Denaturing Gradient Gel Electrophoresis (DGGE). Further sequencing of the most representative bacterial bands revealed that diverse and distinct bacterial communities were found in each system unit, being γ-Proteobacteria and Bacteroidetes present mainly in all of them, while Firmicutes was observed in HFCW and BF. Members of the Actinobacteria group, although found in HFCW and VFCW, seemed to be more abundant in BF units. Finally, some representatives of α, ß and δ-Proteobacteria, Acidobacteria and Chloroflexi were also retrieved from some samples. On the other hand, a lower archaeal diversity was found in comparison with the bacterial population. Cluster analysis of the DGGE bacterial band patterns showed that community structure was related to the design of the treatment system and the organic matter load, while no clear relation was established between the microbial assemblage and the wastewater influent.

First Report of Ilyonectria macrodidyma Associated with Black Foot Disease of Grapevine in Brazil.

Cultivated grapevine (Vitis labrusca and V. vinifera) is of considerable economic importance to the Brazilian fruit industry for both fresh market consumption and for the production of wines, sparkling beverages, and juices. Black foot disease is caused by fungi of the genera Ilyonectria P. Chaverri & C. Salgado (anamorph: Cylindrocarpon Wollew.), Campylocarpon Halleen, Schroers & Crous, and Cylindrocladiella Boesew. In 2012, 4- to 40-year-old grapevines (Vitis spp.) showing reduced vigor, vascular lesions, necrotic root lesions, delayed budding, vine decline, and death were collected from seven locations at Rio Grande do Sul state, Brazil. Fungal isolations were made from root fragments and crown lesions (at least 2 cm above the bottom) on potato dextrose agar (PDA) medium added with 0.5 g L-1 streptomycin sulfate. Eight isolates were obtained and identified on the basis of morphological features and multi-gene analysis (rDNA-ITS, ß-tubulin, and histone H3) as Ilyonectria macrodidyma (Halleen, Schroers & Crous) P. Chaverri & C. Salgado. One representative isolate (Cy5UFSM) was used for more detailed morphological and molecular characterization, and pathogenicity confirmation. When incubated in the dark at 20°C for 7 to 10 days, colonies of felty straw-colored mycelium (3) 4.79 cm diameter on average were observed. No sporodochia or other fruiting bodies were produced on carnation leaf agar (CLA) medium after 30 days. Microconidia that were produced after 5 weeks on spezieller nährstoffarmer agar (SNA) medium with addition of two pieces of 1 cm2 filter paper showed ovoid and ellipsoid shape (6.4 × 3.6 µm) and one-septate macroconidia (17.3 × 4.1 µm). To confirm the species, primer pairs ITS1 and ITS4 (4); Bt2a and Bt2b; and H3-1a and H3-1b (2) were used to amplify the ITS1-5.8S rRNA-ITS2, part of the ß-tubulin and histone H3 genes, respectively. Sequences of these three regions showed 99, 100, and 100% of homology with I. macrodidyma, respectively. To confirm pathogenicity, 4-month-old rooted cuttings of V. labrusca cv. Bordô were inoculated by immersing them in a conidial suspension of the isolate (106 conidia ml-1) for 60 min (1). Thirty days later, inoculation was performed again by drenching the crown with 40 ml of 106 conidia ml-1 suspension to ensure infection of the roots. In the control treatment, plants were inoculated with sterile distilled water. Plants inoculated with I. macrodidyma showed necrosis of the leaf ribs, reduction in root mass, root and crown necrosis, browning of vessels, drying of shoots, and death. I. macrodidyma was re-isolated from the crown necrosis and vascular lesions, confirming Koch's postulates. To our knowledge, this is the first report of I. macrodidyma associated with black foot disease of grapevine in Brazil, which poses considerable threat to the industry unless management options are realized. References: (1) A. Cabral et al. Phytopathol. Mediterr. 51:340, 2012. (2) N. L. Glass et al. Appl. Environ. Microbiol. 61:1323, 1995. (3) R. W. Rayner. A Mycological Colour Chart. Commonwealth Mycological Institute and British Mycological Society, 1970. (4) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, CA, 1990.

First Report of "Cylindrocarpon" pauciseptatum Associated with Black Foot Disease of Grapevine in Brazil.

Since 1999, the decline of American grapevines (Vitis labrusca L.) has been common in Rio Grande do Sul, Brazil (1). In August 2012, V. labrusca with black foot symptoms were collected in vineyards in the Serra Gaúcha Region. Symptomatic plants had low vigor, vascular lesions, delayed budding, and decline and death of vines. Symptomatic roots had necrotic lesions and reduced biomass. Fungal isolations were made from necrotic root and crown fragments (own-rooted cultivar) on potato dextrose agar (PDA) medium amended with 0.5 g L-1 streptomycin sulfate. Putative colonies of "Cylindrocarpon" pauciseptatum Schroers & Crous were obtained from single macroconidia isolations. Two isolates were used to confirm the identity of isolated colonies: Cy12UFSM and Cy13UFSM. After incubation in the dark for 10 days at 20°C, the isolated mycelial colonies, which were cottony white to felty in texture, became dark orange to brown. Both isolates produced chlamydospores in chains at 40 days. Chlamydospores of Cy12UFSM and Cy13UFSM were 9 to 12 µm and 5 to 11.5 µm in diameter. Sporodochia formation on carnation leaf agar (CLA) medium was observed after 30 days. To encourage development of conidia, the isolates were grown on spezieller nährstoffarmer agar (SNA) medium for five weeks at 20°C with addition of two pieces of 1 cm2 filter paper. Microconidia of Cy12UFSM were 4 to 8.5 × 3.5 to 5 µm and those of Cy13UFSM were 3.5 to 7.5 × 3 to 5 µm. Macroconida were predominantly 3-septate (Cy12UFSM was 36 to 45 × 7.5 to 9 µm and Cy13UFSM was 30 to 38 × 7.5 to 8 µm), but 1-, 2- septate macroconidia were observed. The sizes of the three spore types and colony morphology for our isolates were similar to those described by Schroers et al. (3) for "C." pauciseptatum. To further confirm the identity of Cy12UFSM and Cy13UFSM, multi-gene DNA sequence analysis (rDNA-ITS, ß-tubulin, and histone H3) was conducted using primer pairs ITS1 and ITS4 (4), Bt2a and Bt2b, and H3-1a and H3-1b (2), which amplify the ITS1-5.8S rRNA-ITS2 genes, part of the ß-tubulin gene, and the histone H3 gene, respectively. Sequences of these three regions had 99, 99, and 97% similarity with references sequences of "C." pauciseptatum (isolate Cy238; accessions ITS [JF735307]; ß-tubulin [JF735435], and histone H3 [JF735582], respectively). To evaluate pathogenicity, 4-month-old rooted cuttings of V. labrusca cv. Bordô were inoculated with two isolates by immersing them in a conidial suspension (106 conidia ml-1) for 60 min. Ten single-vine replicates were used for each isolate, and 10 water-inoculated vines were included as controls. Thirty days after inoculation, vines were re-inoculated with 40 ml of a 106 conidia ml-1 suspension to ensure root infection. After 4 months, the inoculated plants had reduced root mass relative to controls (39.18% for Cy12UFSM and 18.27% for Cy13UFSM). Inoculated plants also had root and crown necrosis, vascular lesions, shoot decline, and vine mortality (60 and 80% mortality for Cy12UFSM and Cy13UFSM, respectively). All water-inoculated control plants remained symptomless. The fungi Cy12UFSM and Cy13UFSM were re-isolated from infected woody tissues, confirming Koch's postulates. To our knowledge, this is the first report of "C." pauciseptatum associated with black foot disease of grapevine in Brazil, which may potentially impact the sustainability of grapevine nurseries and vineyard productivity. References: (1) L. R. Garrido et al. Fitopatol. Brasil. 29:548, 2004. (2) N. L. Glass et al. Appl. Environ. Microbiol. 61:1323, 1995. (3) H. J. Schoers et al. Mycol. Res. 112:82, 2008. (4) T. J. White et al. Amplification Pages 315-322 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, CA, 1990.

Dynamics of microbial diversity profiles in waters of different qualities. Approximation to an ecological quality indicator.

Over the past two decades, the amount of reclaimed water has increased throughout the world to face the current water shortage, and as a consequence there is an increasing interest to develop good indicators of water quality, beyond the traditional fecal indicators. In order to meet this need, in this work the microbial profiles of different wastewater treatment plant effluents, both secondary and tertiary, were studied and compared with water samples from an uncontaminated natural aquifer. Taking into account the most abundant phylogenetic groups found in these water samples, we calculated the Bacteroidetes, Gammaproteobacteria and Nitrospira/Betaproteobacteria (BGN:ß) ratio and found significant differences between the mean ratios of the four water qualities. The secondary effluent ratios were never below 1.3 and the tertiary effluent and groundwater ratios were never over 0.85. Furthermore, calculation of this index with previous published data supports our results and indicates that the BGN:ß ratio is a possible alternative indicator of water quality.

Impacto de una intervención en alimentación y nutrición en escolares / Impact of food and nutrition intervention on students in Santiago

Introducción: Las intervenciones a nivel escolar constituyen una de las estrategias más importantes para enfrentar la obesidad en la población infantil. Objetivo: Determinar los cambios en los patrones de alimentación y estado nutricional en una intervención de 2 años de duración en alimentación saludable y actividad física en escolares. Sujetos y Método: Se intervinieron durante 2 años a 2.527 estudiantes de primero a cuarto básico de escuelas básicas de las comunas de Santiago Centro, Estación Central y Peñalolén, en Alimentación- Nutrición y Actividad física. A cada apoderado se le realizó una Encuesta de Frecuencia de Alimentos y a los escolares una evaluación antropométrica al inicio y final de la intervención. Resultados: De 2.527 estudiantes intervenidos finalizaron 1.453. La prevalencia de obesidad disminuyó de un 23,4 a 20,1 por ciento. Los escolares obesos incrementaron de forma significativa el consumo de frutas (p < 0,05), pescado (p < 0,01) y leguminosas (p < 0,05) y redujeron el consumo de bebidas gaseosas (p < 0,01) y pasteles/dulces/chocolates (p < 0,01). Conclusión: Los resultados de este estudio demuestran que la intervención en los colegios en alimentación saludable y actividad física, puede mejorar el estado nutricional en escolares con sobrepeso y obesidad e incrementar el consumo de alimentos saludables.

Introduction: School interventions are one of the most important strategies to combat obesity in children. Objective: To determine changes in eating patterns and nutritional status after an intervention of two years long that promoted healthy eating and physical activity in school children. Subjects and Method: 2,527 students, between first and fourth grade, were intervened for two years in the districts of Santiago Centro, Estacion Central and Peñalolen regarding Food, Nutrition and Physical Activity. Each parent underwent a Food Frequency Survey and the students were anthropometrically assessed at the beginning and at the end of the intervention. Results: 1,453 out of 2,527 completed the whole process. The prevalence of obesity decreased from 23.4 to 20.1 percent Obese schoolchildren significantly increased fruit consumption (p < 0.05), fish (p < 0.01) and legumes ( p < 0.05 ) and reduced the consumption of soft drinks (p < 0.01) and cakes/candy/chocolates (p < 0.01). Conclusion: The results of this study demonstrate that interventions in schools on healthy eating and physical activity can improve the nutritional status of obese and overweighed children and increase healthy food consumption.

[Impact of an intervention on diet and physical activity on obesity prevalence in schoolchildren]. / Impacto de una intervención en alimentación y actividad física sobre la prevalencia de obesidad en escolares.

In Chile childhood obesity is a growing public health problem. Intervention programs within schools have shown variable results, with better impacts when multiple aspects are involved and included the entire educational community. The objective of the study was to evaluate the effect on the nutritional status of children in intervention schools within 2 years of duration (Healthy Living Program). The sample included 2,527 students first through fourth grade of 3 counties of Santiago. The students were intervened and followed for a period of two years in their food and nutrition habits, physical activity and self-care practices, by a team of nutritionists and physical education teachers. Weight and height were measured at start of program, end of the first and second years of intervention, under standardized conditions and calculated the Z score of BMI and nutritional status according to the WHO reference 2007. At the end of the second year 1,453 children were reassessed. There was a significant decrease in BMI Z score in obese children (-0.3 SD) and obesity decreased from 21.8% to 18.4% at the end of the intervention. 75% of schoolchildren obese and 60.5% overweight decreased their BMI Z score, reduction that was greater in men and students in the upper grades. 51.9% of normal weight children increased their BMI Z-score age, although most less than 0.5 SD. The intervention in education, nutrition and physical activity among schoolchildren in three communes of Greater Santiago was effective in reducing the prevalence of obesity (-3.4 percentage points). The big challenge is to find mechanisms to give continuity to the program and evaluate long-term effects.

En Chile la obesidad infantil es un creciente problema de salud pública. Los programas de intervención al interior de las escuelas han mostrado resultados variables, con mejores resultados cuando se incluyen diversas variables y a toda la comunidad educativa. El objetivo del estudio fue evaluar el efecto sobre el estado nutricional de un programa realizado al interior de las escuelas, de 2 años de duración (Programa Vive Sano). Se estudiaron 2.527 escolares de primero a cuarto año de educación básica, de 3 comunas de la Región Metropolitana de Chile, que fueron intervenidos en alimentación, nutrición, actividad física y autocuidado de la salud con un equipo de Nutricionistas y Profesores de educación física. Se evaluó peso y talla al ingreso al programa y al final del primer y segundo año de intervención, en condiciones estandarizadas. Se calculó puntaje Z del IMC y estado nutricional según la referencia OMS 2007. Al final del segundo año 1.453 niños fueron reevaluados. Hubo una disminución significativa en puntaje Z del IMC-edad en los escolares obesos (-0,3 DE) y la prevalencia global de obesidad disminuyó de 21,8% a 18,4% al final de la intervención. El 75% de los escolares con obesidad y 60,5% con sobrepeso disminuyó su Z score IMC, siendo mayor la reducción en el sexo masculino y en los cursos superiores. El 51,9% de los estudiantes con peso normal aumentó su puntaje Z de IMC-edad, aunque mayoritariamente menos de 0,5 DE. Se puede concluir que la educación en alimentación y actividad física realizada por profesionales fue efectiva en reducir la prevalencia de obesidad (-3,4 puntos porcentuales). El gran desafío es buscar mecanismos para darle continuidad al programa y evaluar los efectos a largo plazo.

Exploring work organisation and stress in the mining industry in Chile / Organización del trabajo y estrés en trabajadores de la industria minera de Chile

La Organización del Trabajo se define como la forma en que el trabajo es diseñado y a los factores económicos que influyen en el diseño de éste. La teoría de rol y los principios de la comunidad ocupacional proveyeron el marco interpretativo para explorar cómo la organización del trabajo predice el estrés en los trabajadores de planta y subcontratados. Se realizó una encuesta a 451 trabajadores en 4 ciudades mineras del norte de Chile, más preguntas abiertas acerca de la percepción del trabajo. La serie de regresiones jerárquicas realizadas mostró que los factores de organización del trabajo asociados a roles explicaron la mayor varianza en el estrés. Respecto a las preguntas abiertas, los trabajadores valoraron la amistad como la principal fuente de bienestar y la falta de apoyo organizacional como la principal fuente de problemas. La diferencia de resultados entre grupos (planta y subcontratados) pone de relieve las inequidades sociales y laborales. Los programas de prevención de riesgos en este ámbito debieran considerar los principios de la comunidad ocupacional en los trabajadores de planta. Asimismo, se sugiere educar en organización del trabajo a los subcontratistas, para promover la salud ocupacional y la seguridad hacia estándares mínimos.

Work organisation refers to the way work is designed and managed, and to the economic factors that shape job design. Role theory and occupational community notions provided the framework for exploring how work organisation predicts work stress in staff and subcontractor groups in the mining industry. A survey was carried out on 451 workers in four Chilean mining cities to explore work organisation and stress issues. Open-ended questions about job perceptions were also asked. A series of hierarchical regressions showed that work organisation factors based on role relationships explain the main variance observed in strains and organisational hazards. Workers' opinions highlight work mates' friendship as the most important source of well-being, and lack of organisational support as the main source of problems. Differences between groups highlight social and work inequalities. Intervention programmes addressing work organisation and stress in this sector should consider occupational community principles for the staff group. Education in work organisation is recommended to raise occupational health and safety minimum standards in subcontractor companies.