Utilidad de la ECMO sobre el injerto pulmonar disfuncionante en un modelo porcino estandarizado de trasplante unipulmonar / [Usefulness of ECMO on dysfunctional lung graft in a standardized porcine model of one-lung transplant]

Objetivo: Establecer un modelo de muerte encefálica y trasplante pulmonar y analizar el posible papel protector del oxigenador de membrana extracorpóreo (ECMO).Métodos: Se emplearon 20 cerdos hembras, 10 donantes y 10 receptoras. Las receptoras del Grupo A (n = 5) fueron sometidas a un trasplante unipulmonar izquierdo (Tx-UPI) sin ECMO. Las receptoras del Grupo B (n = 5) se sometieron a un Tx-UPI con ECMO venoarterial (ECMO-VA). Se recopilaron datos funcionales e histológicos en situación basal, a los 10 minutos de clampar el hilio derecho (Tiempo 1) y a las 2 horas (Tiempo 2). Se analizó la expresión proteica de marcadores de inflamación y de la ruta de hipoxia.Resultados: El modelo de muerte encefálica empleado, seguido de un tiempo de isquemia frío prolongado (20 horas) dio lugar a la aparición de un edema pulmonar severo. Tras el implante, 3 receptores del grupo A sobrevivieron hasta el Tiempo 2, falleciendo 2 por edema pulmonar masivo. Por el contrario, todos los animales del Grupo B sobrevivieron, siendo la PaO2 en ese momento de 462,72 mmHg. Hubo un incremento de la expresión de IL6, TNF, PCR, AC IX y el VEGF, así como un descenso en la expresión de IL8 y GLUT1, al usar la ECMO.Conclusiones: Se ha desarrollado un modelo porcino estandarizado y reproducible de muerte encefálica, que simula el proceso clínico de la donación pulmonar. Este modelo puede servir de plataforma para investigar posibles dianas terapéuticas. (AU)

Objective: Establish a model of brain death and lung transplantation and analyze the possible protective role of extracorporeal membrane oxygenation (ECMO).Methods: 20 female pigs were used, 10 donors and 10 recipients. Group A recipients (n = 5) underwent left-sided single- lung transplantation (LUCT-Tx) without ECMO. Group B recipients (n = 5) underwent ICU-Tx with venoarterial ECMO (VA-ECMO). Functional and histological data were collected at baseline, 10 minutes after clamping the right hilum (Time 1) and 2 hours (Time 2). Protein expression of inflammation markers and the hypoxia pathway was analyzed.Results: The brain death model used, followed by a prolonged cold ischemia time (20 hours) gave rise to the appearance of severe pulmonary edema. After implantation, 3 group A recipients survived until Time 2, with 2 dying from massive pulmonary edema. In contrast, all the animals in Group B survived, with PaO2 at that time being 462.72 mmHg. There was an increase in the expression of IL6, TNFα, CRP, AC IX and VEGF, as well as a decrease in the expression of IL8 and GLUT1, when using ECMO.Conclusions: A standardized and reproducible porcine model of brain death has been developed, which simulates the clinical process of lung donation. This model can serve as a platform to investigate possible therapeutic targets. (AU)

[Preliminary study of the temporal variables of continuous speech in patients with neurodegenerative syndromes of the frontotemporal lobar degeneration spectrum]. / Estudio preliminar de variables temporales del habla continua en pacientes con síndromes neurodegenerativos del espectro degeneración lobar frontotemporal.

INTRODUCTION: Neurodegenerative diseases, especially frontotemporal lobar degeneration and Alzheimer's disease, often lead to impaired language functions, and so speech analysis can provide objective measures with which to classify the different syndromes. AIM: To study the nature, cognitive correlates and clinical utility of 21 variables related to speech and silence times. SUBJECTS AND METHODS: Derivation of acoustic variables with Praat in three spontaneous speech tasks conducted in 22 subjects, distributed in six diagnostic groups (five with neurodegenerative diseases + control). A descriptive analysis is performed, with ROC and principal component curves, to study how acoustic variables are related to the different neurodegenerative syndromes and what information they can provide. RESULTS: Three groups of variables are identified related, respectively, to: a) total number of silent pauses and total duration of the task; b) variability of the phonic groups; and c) variability of the periods of silence. These components correlate differentially with the different syndromes studied. CONCLUSIONS: Detailed analysis of speech and silence times can provide relevant information for the diagnosis of different neurodegenerative syndromes that are not reflected in traditional neuropsychological assessments. Thus, the total number of silent pauses may be a valuable aid in discriminating patients with lexical access deficits, phonic group parameters seem to reflect motor speech problems, and pause variability is associated with dysexecutive and global impairment.

TITLE: Estudio preliminar de variables temporales del habla continua en pacientes con síndromes neurodegenerativos del espectro degeneración lobar frontotemporal.Introducción. Las enfermedades neurodegenerativas, especialmente la degeneración lobar frontotemporal y la enfermedad de Alzheimer, conllevan a menudo una alteración de las funciones del lenguaje, por lo que el análisis del habla puede proporcionar medidas objetivas para clasificar los diferentes síndromes. Objetivo. Estudiar la naturaleza, correlatos cognitivos y utilidad clínica de 21 variables relacionadas con el tiempo de habla y de silencio. Sujetos y métodos. Derivación de variables acústicas con Praat en tres tareas de habla espontánea en 22 sujetos, distribuidos en seis grupos de diagnóstico (cinco con enfermedades neurodegenerativas + control). Se realiza un análisis descriptivo, con curvas ROC y de componentes principales, para estudiar cómo las variables acústicas se relacionan con los distintos síndromes neurodegenerativos y qué información pueden aportar. Resultados. Se identifican tres grupos de variables relacionadas, respectivamente, con: a) número total de pausas silenciosas y duración total de la tarea; b) variabilidad de los grupos fónicos, y c) variabilidad de los períodos de silencio. Dichas componentes se correlacionan diferencialmente con los distintos síndromes estudiados. Conclusiones. El análisis detallado del tiempo de habla y de silencio puede aportar información relevante para el diagnóstico de diferentes síndromes neurodegenerativos, no reflejado en las evaluaciones de neuropsicología tradicionales. Así, el número total de pausas silenciosas puede tener valor para discriminar los pacientes con déficits de acceso léxico, los parámetros del grupo fónico parecen reflejar los problemas motores del habla, mientras que la variabilidad de las pausas se asocia con el deterioro disejecutivo y global.

Estudio preliminar de variables temporales del habla continua en pacientes con síndromes neurodegenerativos del espectro degeneración lobar frontotemporal / Preliminary study of the temporal variables of continuous speech in patients with neurodegenerative syndromes of the frontotemporal lobar degeneration spectrum

Introducción: Las enfermedades neurodegenerativas, especialmente la degeneración lobar frontotemporal y la enfermedad de Alzheimer, conllevan a menudo una alteración de las funciones del lenguaje, por lo que el análisis del habla puede proporcionar medidas objetivas para clasificar los diferentes síndromes. Objetivo: Estudiar la naturaleza, correlatos cognitivos y utilidad clínica de 21 variables relacionadas con el tiempo de habla y de silencio. Sujetos y métodos: Derivación de variables acústicas con Praat en tres tareas de habla espontánea en 22 sujetos, distribuidos en seis grupos de diagnóstico (cinco con enfermedades neurodegenerativas + control). Se realiza un análisis descriptivo, con curvas ROC y de componentes principales, para estudiar cómo las variables acústicas se relacionan con los distintos síndromes neurodegenerativos y qué información pueden aportar. Resultados: Se identifican tres grupos de variables relacionadas, respectivamente, con: a) número total de pausas silenciosas y duración total de la tarea; b) variabilidad de los grupos fónicos, y c) variabilidad de los períodos de silencio. Dichas componentes se correlacionan diferencialmente con los distintos síndromes estudiados. Conclusiones: El análisis detallado del tiempo de habla y de silencio puede aportar información relevante para el diagnóstico de diferentes síndromes neurodegenerativos, no reflejado en las evaluaciones de neuropsicología tradicionales. Así, el número total de pausas silenciosas puede tener valor para discriminar los pacientes con déficits de acceso léxico, los parámetros del grupo fónico parecen reflejar los problemas motores del habla, mientras que la variabilidad de las pausas se asocia con el deterioro disejecutivo y global.(AU)

Introduction: Neurodegenerative diseases, especially frontotemporal lobar degeneration and Alzheimer’s disease, often lead to impaired language functions, and so speech analysis can provide objective measures with which to classify the different syndromes. Aim: To study the nature, cognitive correlates and clinical utility of 21 variables related to speech and silence times. Subjects and methods. Derivation of acoustic variables with Praat in three spontaneous speech tasks conducted in 22 subjects, distributed in six diagnostic groups (five with neurodegenerative diseases + control). A descriptive analysis is performed, with ROC and principal component curves, to study how acoustic variables are related to the different neurodegenerative syndromes and what information they can provide. Results: Three groups of variables are identified related, respectively, to: a) total number of silent pauses and total duration of the task; b) variability of the phonic groups; and c) variability of the periods of silence. These components correlate differentially with the different syndromes studied. Conclusions: Detailed analysis of speech and silence times can provide relevant information for the diagnosis of different neurodegenerative syndromes that are not reflected in traditional neuropsychological assessments. Thus, the total number of silent pauses may be a valuable aid in discriminating patients with lexical access deficits, phonic group parameters seem to reflect motor speech problems, and pause variability is associated with dysexecutive and global impairment.(AU)

SARS-CoV-2 IgG response in symptomatic and asymptomatic COVID-19-infected healthcare workers.

BACKGROUND: Healthcare workers (HCWs) accounted for a significant proportion of COVID-19 infections worldwide. Retrospective seroprevalence surveys are often used to screen for unidentified previous infection with SARS-CoV-2. However, the rate of humoral response in HCWs affected by COVID-19 is not well-defined. AIMS: To assess the specific IgG humoral response in symptomatic and asymptomatic SARS-CoV-2-infected HCWs and identify potential factors associated with humoral response. METHODS: We prospectively recruited 204 HCWs with RT-PCR-confirmed COVID-19 infection to evaluate SARS-CoV-2 humoral response. Serum-IgG antibodies against SARS-CoV-2 were analysed using two commercially available serological assays. A logistic regression was performed to identify independent factors associated with positive IgG serology test. RESULTS: Overall, the SARS-CoV-2 IgG seropositivity rate was 77%. This seropositivity rate was higher in symptomatic than in asymptomatic COVID-19 infection (83% versus 57%; P < 0.001) and in older HCWs.. The seropositivity rate did not diminish with time. In logistic regression, only a history of COVID-19 symptoms and age were identified as independent factors associated with the detection of anti-SARS-CoV-2 IgG antibodies. CONCLUSIONS: SARS-CoV-2 IgG antibodies are found significantly more frequently in symptomatic and in older HCWs. The fact that not all COVID-19 HCWs develop detectable IgG is vital for the interpretation of COVID-19 seroprevalence surveys.

Prediction of adverse perinatal outcome by serum placental growth factor and soluble fms-like tyrosine kinase-1 in women undergoing induction of labor.

OBJECTIVE: To investigate the additive value of serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1), measured within 24 h prior to induction of labor, to the performance of screening for adverse perinatal outcome provided by maternal risk factors and the cerebroplacental ratio (CPR). METHODS: This was a prospective observational study of 795 singleton pregnancies undergoing induction of labor at ≥ 37 weeks' gestation. Before induction of labor, Doppler ultrasound was used to measure the pulsatility index (PI) in the umbilical artery (UA) and fetal middle cerebral artery (MCA) and maternal blood was obtained for measurement of serum PlGF and sFlt-1. The measured UA-PI, MCA-PI and their ratio (CPR) were converted to multiples of the median (MoM) after adjustment for gestational age, and the measured PlGF and sFlt-1 were converted to MoM after adjustment for gestational age, maternal characteristics and the machine used for the assays. Univariable and multivariable logistic regression analysis was used to determine factors that provided a significant contribution in the prediction of adverse perinatal outcome, defined as the presence of any one of Cesarean section for non-reassuring fetal status in labor, umbilical arterial or venous cord blood pH ≤ 7 and ≤ 7.1, respectively, 5-min Apgar score < 7 or admission to the neonatal intensive care unit for ≥ 24 h. The detection rate (DR) and false-positive rate (FPR) in screening for adverse perinatal outcome were determined. RESULTS: In pregnancies with adverse perinatal outcome, compared to those without, median serum PlGF MoM was lower (0.44; interquartile range (IQR), 0.30-0.82 vs 0.60; IQR, 0.36-1.07; P = 0.003), but median sFlt-1 MoM was not significantly different (P = 0.080). Multivariable regression analysis demonstrated that, in the prediction of adverse perinatal outcome, there was significant contribution from maternal risk factors and CPR MoM but not PlGF MoM or sFlt-1 MoM. The performance of screening for adverse perinatal outcome achieved by maternal risk factors alone (DR of 28.9% at FPR of 10%) was not improved by the addition of CPR (DR of 33.8% at FPR of 10%) (area under the curve, 0.702; 95% CI, 0.654-0.750 vs 0.712; 95% CI, 0.664-0.760; P = 0.233). CONCLUSION: Serum PlGF and sFlt-1, measured within 24 h prior to induction of labor, do not provide a significant additional contribution to maternal risk factors in the prediction of adverse perinatal outcome. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Economic evaluation of the environmental impact of a dairy cattle intensive production cluster under arid lands conditions.

At a global level, dairy cow production systems (DCPS) are important sources of nourishment and profits, but they generate environmental impacts such as overexploitation of different resources including water, lands and fossil energy. Quantification of water and carbon footprint to define mitigation strategies and a more rational use of natural resources, is a reiterated claim. The aim of this study was to perform an economic evaluation of the environmental impact of the DCPS from the Comarca Lagunera, Mexico (24°N, 102°W, 220 mm, hot-semiarid climate) We contrasted the economic value (EV) generated by the DCPS with respect to the economic costs (EC) due to the greenhouse gas emissions (GHGE) and the water footprint (WFP) of this DCPS. While quantifications of GHGE considered those proposed by the Intergovernmental Panel on Climate Change, the WFP involved the use of blue, gray and green water by the DCPS and related activities. Quantification of the EC of WFP considered an international average price of water. In the year 2017, the Comarca Lagunera registered a dairy cow inventory of 493 144 heads, with 227 142 lactating cows, which produced 2386 million liters of milk per year with an annual average EV of €525.3 million. The EC (€, millions) generated by the GHGE and WFP were €311.8 and €11 980.7, respectively, with a total EC of € 12 292.5 million. When the EV of milk production and the total environmental EC are compared, the contrast demonstrates not only the noteworthy environmental impact but also the significant and senseless biological and EC. In addition, having a large dairy cow concentration creates pollution concerns and the DCPS transfers both nutrients and water resources from an ecologically vulnerable arid region. Therefore, some mitigation strategies such as, better cow genotype, feed and manure management combined with the production of forages and grains in a different geographical region are suggested to promote an optimum use of water in order to uphold the social, economic and biologic sustainability of the Comarca Lagunera, Mexico.

Comparing student and staff perceptions of the "Educational Climate" in Spanish Dental Schools using the Dundee Ready Education Environment Measure.

OBJECTIVE: To compare the perceptions of students and teachers of the "Educational Climate" (EC) in Spanish public dental schools. METHODS: A group of 1064 students and 354 teachers from six Spanish public dental schools responded to the DREEM questionnaire. This has 50 items grouped into five subscales: perception of learning (Learning); perception of teachers (Teachers); academic self-perceptions (Academic); perception of the atmosphere in the faculty (Atmosphere); and social self-perceptions (Social). The DREEM scale provides results for each item, each subscale and the overall EC. RESULTS: The EC scores were 123.2 (61.6%) for the students and 134.1 (67.0%) for the teachers (P<.001). The scores of the students and teachers for the subscales were, respectively: 27.9 (58.1%) and 30.2 (63.0 %) for Learning (P<.001); 26.8 (60.9%) and 32.6 (74.1%) for Teachers (P<.001); 20.7 (64.7%) and 20.5 (64.0%) for Academic (P=.333); 29.9 (62.3%) and 33.7 (70.3%) for Atmosphere (P<.001); and 17.9 (64.0%) and 16.9 (60.5%) for Social (P<.001). The students identified six problematic items (12.0 %) compared to only two (4.0 %) highlighted by the teachers. CONCLUSION: The students and teachers considered the EC to be "more positive than negative" in Spanish public dental schools; and the different subscales to be "positive and acceptable." The teachers did, however, evaluate the EC, and specifically the learning-teaching process, more positively than their students, identifying fewer problematic educational aspects. Both groups agreed on the need to: improve support systems for students who suffer from stress and reduce teaching based on "factual learning."

Effect of change in posture on maternal functional hemodynamics at 35-37 weeks' gestation.

OBJECTIVES: To evaluate the effect of posture change from the supine to the sitting position and before and after passive leg raising on maternal functional hemodynamics in pregnant women at 35-37 weeks' gestation, and to compare the changes in pregnancies that subsequently developed pre-eclampsia (PE) or gestational hypertension (GH) with those that remained normotensive. METHODS: In 2764 singleton pregnancies at 35-37 weeks' gestation, maternal cardiovascular parameters were measured using an automated non-invasive cardiac monitor. The hemodynamic response to a change from the supine to the sitting position and before and after passive leg raising in the left lateral position was examined and compared between women who subsequently developed PE or GH and those who remained normotensive. RESULTS: In normotensive singleton pregnancies at 35-37 weeks' gestation, both change from the supine to the sitting position and passive leg raising were associated with an increase in cardiac index and stroke volume index and a decrease in total peripheral resistance index; there was a small increase in mean arterial pressure with both postural changes and a slight decrease in heart rate with passive leg raising. In pregnancies that subsequently developed PE or GH, compared with normotensive pregnancies, cardiac index and stroke volume index were lower and total peripheral resistance index was higher. In general, change from the supine to the sitting position and passive leg raising were associated with similar but less marked changes in cardiovascular parameters as in normotensive pregnancies. CONCLUSIONS: Paradoxically, in late third-trimester normal pregnancy, both change from the supine to a sitting position and passive leg raising may result in an increase in preload with a consequent increase in cardiac and stroke volume indices and a decrease in total peripheral resistance index. In pregnancies that develop PE or GH, the effects of postural change on cardiovascular parameters are similar but less marked than in normotensive pregnancies. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Medición de la participación en niños y adolescentes con y sin discapacidad: una revisión sistemática / Measuring participation in children and adolescents with and without disabilities: a systematic review

Resumen Introducción: De acuerdo a la Clasificación Internacional del Funcionamiento de la Discapacidad y la Salud (CIF), la participación se define como "el involucramiento del sujeto en situaciones de la vida" y es un aspecto fundamental en el desarrollo de los niños, niñas y adolescentes. En el caso de niños(as) con discapacidad, permite una mejor comprensión del posible impacto de las deficiencias en la vida cotidiana. Objetivo: Evaluar las escalas de medición de la participación en niños, niñas y adolescentes con y sin discapacidad. Método: Revisión sistemática. Se incluyeron estudios de va lidación de instrumentos de evaluación de la participación en niños(as) y adolescentes con y sin discapacidad sin restricción de lenguaje. La búsqueda se realizó en Pubmed, EMBASE, CINAHL, The Cochrane Library, Biblioteca Virtual de la Salud, Opengrey y Google Scholar. Los datos fueron ex traídos y analizados en Microsoft Excel. Registro de protocolo PROSPERO 2015:CRD42015020644. Resultados: De los 1.689 artículos que arrojó la búsqueda electrónica, se identificaron 9 escalas de evaluación de la participación de niños(as) y/o adolescentes con y sin discapacidad. Diversidad en las dimensiones, extensión y aplicación (padres y niños(as)). El número de pacientes incorporados en las validaciones originales es variable, al igual que el porcentaje de niños y/o adolescentes con discapaci dad incluidos en los estudios de validación. Conclusiones: Existe gran variabilidad en las propiedades psicométricas y características de las escalas incluidas en esta revisión, principalmente debido a que el constructo de participación difiere de acuerdo a la cultura, por lo que las escalas seleccionadas re quieren de adaptaciones transculturales para su uso.

Abstract Introduction: According to the International Classification of Functioning, Disability and Health (ICF), participation is defined as "the involvement of the subject in situations of life" and is fun damental in the development of children and adolescents. In case of children with disabilities, participation allows a better understanding of the possible impact of deficiencies in daily life. Objective: To evaluate measurement scales of participation in children and adolescents with and without disabilities. Method: Systematic review. Validation studies of measurement scales of parti cipation in children and adolescents with and without disabilities without language restriction were included. The search was performed in Pubmed, EMBASE, CINAHL, The Cochrane Library, Health Virtual Library, Opengrey and Google Scholar. The data were extracted and analyzed in Microsoft Excel. Protocol Register PROSPERO 2015: CRD42015020644. Results: 1689 articles were collected through electronic search, 9 scales were selected for analysis. Diversity in size and application bet ween the scales selected was found. The number of patients included in the original validations was variable, as the percentage of children and/or adolescents with disabilities included in the validation studies. Conclusions: There is great variability in the psychometric properties and characteristics of the scales included in this review, mainly for which the participation construct differs according to culture, so the selected scales require transcultural adaptations for their use.

Maternal cardiac function at 35-37 weeks' gestation: relationship with birth weight.

OBJECTIVE: To evaluate the relationship between maternal cardiovascular parameters and neonatal birth weight and examine the potential value of these parameters in improving the prediction of small-for-gestational-age (SGA) and large-for-gestational-age (LGA) neonates provided by maternal characteristics and medical history. METHODS: In 2835 singleton pregnancies maternal characteristics and medical history were recorded and maternal cardiovascular parameters were measured. The observed measurements of cardiovascular parameters were expressed as multiples of the normal median (MoM) values after adjustment for those characteristics found to provide a substantial contribution to their measurement. Regression analysis was used to determine the significance of association between the normalized values of the cardiovascular parameters with birth-weight Z-score. Multivariable logistic regression analysis was then used to determine if the maternal factors, fetal biometry and maternal cardiovascular parameters had a significant contribution to predicting SGA and LGA neonates. The performance of screening was determined by the area under receiver-operating characteristics curves (AUC). RESULTS: In the study population there were significant positive associations between maternal cardiac output and heart rate with neonatal birth-weight Z-score, and significant negative associations between total peripheral resistance and mean arterial pressure (MAP) with neonatal birth-weight Z-score. In pregnancies delivering SGA neonates (n = 249 (8.8%)), cardiac output and heart rate were lower and total peripheral resistance and MAP were higher, whereas in pregnancies delivering LGA neonates (n = 292 (10.3%)) cardiac output and heart rate were higher and total peripheral resistance and MAP were lower. The performance of screening for delivery of SGA neonates achieved by maternal characteristics and fetal biometry was not improved by the measurement of maternal cardiovascular parameters. There was a small but significant improvement in the performance of screening for delivery of LGA neonates by maternal factors and fetal biometry with the addition of maternal heart rate (comparison of AUC, P = 0.0095). CONCLUSIONS: There are significant associations between maternal cardiac output, heart rate, total peripheral resistance and MAP and neonatal birth-weight Z-score; such findings reflect the close relationship between maternal cardiac function and fetal demands. However, assessment of these parameters at 35-37 weeks' gestation is unlikely to improve substantially the performance of screening for SGA or LGA neonates provided by a combination of maternal factors and fetal biometry. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

[Measuring participation in children and adolescents with and without disabilities: a systematic review]. / Medición de la participación en niños y adolescentes con y sin discapacidad: una revisión sistemática.

INTRODUCTION: According to the International Classification of Functioning, Disability and Health (ICF), participation is defined as "the involvement of the subject in situations of life" and is fun damental in the development of children and adolescents. In case of children with disabilities, participation allows a better understanding of the possible impact of deficiencies in daily life. OBJECTIVE: To evaluate measurement scales of participation in children and adolescents with and without disabilities. METHOD: Systematic review. Validation studies of measurement scales of parti cipation in children and adolescents with and without disabilities without language restriction were included. The search was performed in Pubmed, EMBASE, CINAHL, The Cochrane Library, Health Virtual Library, Opengrey and Google Scholar. The data were extracted and analyzed in Microsoft Excel. Protocol Register PROSPERO 2015: CRD42015020644. RESULTS: 1689 articles were collected through electronic search, 9 scales were selected for analysis. Diversity in size and application bet ween the scales selected was found. The number of patients included in the original validations was variable, as the percentage of children and/or adolescents with disabilities included in the validation studies. CONCLUSIONS: There is great variability in the psychometric properties and characteristics of the scales included in this review, mainly for which the participation construct differs according to culture, so the selected scales require transcultural adaptations for their use.

Prediction of stillbirth from placental growth factor at 11-13 weeks.

OBJECTIVES: To investigate whether the addition of maternal serum placental growth factor (PlGF) measured at 11-13 weeks' gestation improves the performance of screening for stillbirths that is achieved by a combination of maternal factors and first-trimester biomarkers such as maternal serum pregnancy-associated plasma protein-A (PAPP-A), fetal ductus venosus pulsatility index for veins (DV-PIV) and uterine artery pulsatility index (UtA-PI) and to evaluate the performance of screening with this model for all stillbirths and those due to impaired placentation and unexplained causes. METHODS: This was a prospective screening study of 45 452 singleton pregnancies including 45 225 live births and 227 (0.49%) antepartum stillbirths; 131 (58%) were secondary to impaired placentation and 96 (42%) were due to other or unexplained causes. Multivariable logistic regression analysis was used to determine whether the addition of maternal serum PlGF improved the performance of screening that was achieved by a combination of maternal factors and PAPP-A, DV-PIV and UtA-PI. RESULTS: Significant contribution to the prediction of stillbirth was provided by maternal factor-derived a-priori risk and multiples of the median values of PlGF, DV-PIV and UtA-PI but not of serum PAPP-A. A model combining these variables predicted 42% of all stillbirths and 61% of those due to impaired placentation, at a false-positive rate of 10%; within the impaired placentation group the detection rate of stillbirth < 32 weeks' gestation was higher than that of stillbirth ≥ 37 weeks (71% vs 46%; P = 0.031). CONCLUSIONS: A high proportion of stillbirths due to impaired placentation can be identified effectively in the first trimester of pregnancy. Addition of PlGF improves the performance of screening achieved by other maternal factors and biomarkers. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Management by missions in the healthcare sector / La dirección por misiones en el sector sanitario

This article discusses the importance of the mission statement in the healthcare sector. It's also argued that only formal declaration of the mission it's insufficient to the appropriate professional coordination of doctors, nurses and managers. It's proposed a systematic approach to facilitate the introduction of the mission within the systems of the organization, what is called «Management by missions.» It promotes horizontal and vertical integration between doctors, nurses and managers. Criteria that ensure this integration are specified (AU)

En este artículo se aborda la importancia de la declaración de la misión en instituciones del sector sanitario; también se constata la insuficiencia de esta declaración formal para la adecuada coordinación profesional de médicos, enfermeros y gestores. Se propone un abordaje sistemático que facilite la introducción de la misión en los sistemas de la organización, lo que se denomina «Dirección por misiones». Se explicita como esto promueve la integración horizontal y vertical entre médicos, enfermeros y gestores. Se especifican los criterios que garantizan esa integración (AU)

Management by missions in the healthcare sector.

This article discusses the importance of the mission statement in the healthcare sector. It's also argued that only formal declaration of the mission it's insufficient to the appropriate professional coordination of doctors, nurses and managers. It's proposed a systematic approach to facilitate the introduction of the mission within the systems of the organization, what is called "Management by missions." It promotes horizontal and vertical integration between doctors, nurses and managers. Criteria that ensure this integration are specified.

Pretreatment Combination Reduces Remote Organ Damage Secondary to Intestinal Reperfusion Injury in Mice: Follow-up Study.

BACKGROUND: Intestinal ischemia-reperfusion injury occurs after different surgical treatments, including intestinal transplantation. This harmful process may have an effect in remote organs, leading to multiple organ dysfunction syndrome and death. Therefore, to establish strategies to attenuate local and remote damage constitutes a challenge for experimental and clinical surgeons in the intestinal surgical field. METHODS: We evaluated the effect of ischemic preconditioning and tacrolimus pretreatment applied alone and in combination against local and remote damage caused by prolonged intestinal ischemia-reperfusion injury in a mouse model of warm ischemia. RESULTS: Ischemic preconditioning applied alone and in combination with tacrolimus decreased histological damage (P < .05), number of apoptotic cells (P < .05), nitrosative stress (P < .01), and serum lactate dehydrogenase activity (P < .05) and lowered uremia (P < .05) compared with untreated post-reperfused intestines. Regarding remote organ damage, combination therapy was the unique condition able to attenuate lung (mainly neutrophil infiltration and hemorrhage), liver (sinusoidal congestion and hepatic vacuolization), and kidney (acute tubular necrosis and hydropic degeneration) histological alterations (P < .05), compared with the untreated group. CONCLUSIONS: These results support the application of these strategies in combination to minimize the impact of ischemia-reperfusion injury in the whole organism as a strategy to prevent multiple organ dysfunction syndromes and minimize the clinical impact.

Misión y Visión del Farmacéutico Clínico a través de un Caso de Sospecha de Alopecia Yatrogénica / Mission and Vision of a Clinical Pharmacist Throughout a Possible case of Iatrogenic Alopecia

No disponible

Atención farmacéutica, universidad y sistema sanitario / No disponible

No disponible

Ileal ganglioneuromatosis in a piglet: histopathological and immunohistochemical studies.

Ganglioneuromatosis (GNM) is a rare condition characterized by the benign proliferation of ganglion cells, nerve fibres and supporting cells of the enteric nervous system. Necropsy examination of a female piglet weighing 4 kg revealed a well-demarcated 20 cm segment of terminal ileum with thickening of the wall. Microscopically, the lamina propria was infiltrated by enteric glial cells and large ganglion cells. Within the submucosal and muscular layers, aggregates of neurons were interlaced by Schwann cells and enteric glial cells arranged in concentric rings. Immunohistochemically, the neurons were weakly labelled for S-100 and neuron-specific enolase, Schwann cells expressed S-100 and vimentin and enteric glial cells expressed glial fibrillary acidic protein and S-100. Pathological and immunohistochemical findings supported the diagnosis of ileal GNM.

Pharmacokinetics of the individual enantiomer S-(+)-ketoprofen after intravenous and oral administration in dogs at two dose levels.

The pharmacokinetic of the individual S-(+)-enantiomer of ketoprofen, S-(+)-ketoprofen, after intravenous (IV) and oral (PO) administration was determined in six dogs at 1 and 3 mg/kg. Plasma concentrations were determined by high performance liquid chromatography with ultraviolet detection. The concentration-time curves were analyzed by non-compartmental methods. Steady-state volume of distribution (Vss) and clearance (Cl) of S-(+)-ketoprofen after IV administration were 0.22 ± 0.07 and 0.19 ± 0.03 L/kg, and 0.10 ± 0.02 and 0.09 ± 0.01 L/h/kg, at 1 and 3 mg/kg, respectively. Following PO administration, S-(+)-ketoprofen achieved maximum plasma concentrations of 4.91 ± 0.76 and 12.47 ± 0.62 µg/ml, at two dose levels, respectively. The absolute bioavailability after PO route was 88.66 ± 12.95% and 85.36 ± 13.90%, respectively.

Prevalence of dog erythrocyte antigen 1.1 in galgos (Spanish greyhounds).

Dog erythrocyte antigen (DEA) 1.1 is the most clinically important blood group in dogs, as negative recipients for this group may develop a life-threatening acute haemolytic transfusion reaction if they receive several DEA 1.1 positive blood transfusions. Due to their physical features, galgos are frequently used as blood donors in clinical practice, however, there are no published data regarding the prevalence of DEA 1.1 in this breed. Expression of DEA 1.1 was determined in 118 galgos and 88 dogs of other breeds being screened as potential blood donors, using an immunochromatographic cartridge typing kit (Quick Test DEA 1.1, Alvedia, Lyon, France). Of the total dogs, 53.4per cent (110/206) were positive for DEA 1.1. The prevalence of DEA 1.1 positive blood among our population of galgos and other-breed dogs were 51.7 per cent (61/118) and 55.7 per cent (49/88), respectively. Potential risk of sensitisation in a recipient of other breed following non-typed blood transfusion using blood from galgos was 22.9 per cent. Due to the clinical significance of DEA 1.1 and the high prevalence of this blood group in galgos of Spain, we strongly recommend blood-typing for this group before administering any blood transfusion using galgos as donors, as with transfusions from other commonly used breeds.