Clinical impact of capsule endoscopy on patients with suspected small bowel bleeding: Experience at a highly specialized hospital in Colombia.

INTRODUCTION AND AIMS: Capsule endoscopy is part of the diagnostic approach to patients with suspected small bowel bleeding and data on its clinical impact are still limited in developing countries. The primary aim of the present study was to determine its impact on subsequent diagnostic and therapeutic decisions. MATERIAL AND METHODS: A retrospective study was conducted that included all the patients that underwent capsule endoscopy with the PillCam™ SB 3 Capsule system due to suspected small bowel bleeding treated at the Hospital Universitario Fundación Valle del Lili between January 2011 and December 2020. RESULTS: A total of 158 patients met the inclusion criteria. Mean patient age was 63 years (interquartile range [IQR], 52-74), 53.6% of the patients were women, and high blood pressure was the most frequent comorbidity (43.7%). The main indication was overt bleeding (58.2%). Of all the capsule endoscopies carried out, 63.9% showed lesions that were potentially responsible for bleeding. Medical or surgical treatment was indicated in 63.3% of the case total. Rebleeding at 6 months occurred in 15 patients and there were 2 deaths due to gastrointestinal bleeding at 6 months. CONCLUSIONS: Capsule endoscopy has a high impact on patients with suspected small bowel bleeding, with respect to clinical decision-making, as well as rebleeding, hospitalization, and mortality outcomes. The positivity rate of lesions potentially responsible for bleeding was similar to that reported in developed countries.

[Arthroscopic biceps tenodesis with a «relaxed¼ technique.Clinical and radiological results of a prospective cohort]. / Tenodesis artroscópica del bíceps mediante técnica «relajada¼. Resultados clínicos y radiológicos de una cohorte prospectiva.

INTRODUCTION: in the treatment the long head of the biceps tendon (LHBT) pathology, the «relaxed tenodesis¼ is an arthroscopic articular suprapectoral tenodesis that seeks to lower the tension on the LHBT, and therefore, theoretically avoid persistent pain. OBJECTIVE: to assess clinical and radiological results of «relaxed¼ tenodesis in a prospective cohort of patient with work related illness. MATERIAL AND METHODS: prospective cohort, 54 shoulders with «relaxed¼ tenodesis performed with an intra-articular interference screw by the same surgeon, from October 2014 to 2018, in a level 1 trauma center. Demographic, clinical, functional and radiologic results were analyzed. On 6 months follow-up, a sonographic and clinical assessment was performed. RESULTS: mean age 49 ± 9, mean follow-up 16 ± 4 months. The main diagnosis was a rotator cuff tear in 79%, primary biceps pathology in 10% and other pathologies in 11%. At the end of follow-up, the cohort showed active anterior elevation 157.7 ± 22.7, external rotation 47 ± 16.6, median internal rotation T12, Constant Score 83 ± 12.05 points, subjective shoulder value 83 ± 12.97% and pain visual analogue scale 1.4 ± 1.7 points. One patient had a biceps tear and two had cosmetic arm asymmetry. On ultrasound 98% had the LHBT in situ and 10% had inflammatory changes on the bicipital groove. There were complications in 21% of the sample. CONCLUSIONS: «relaxed biceps tenodesis¼ is a technique that shows good clinical, functional and sonographic results, with low failure rate.

INTRODUCCIÓN: en el tratamiento de la patología del tendón de la cabeza larga del bíceps (TCLB) la tenodesis «relajada¼ es una tenodesis artroscópica suprapectoral alta, que busca disminuir la tensión del TCLB y, por tanto, el dolor persistente. OBJETIVO: evaluar resultados clínicos y radiológicos de la tenodesis «relajada¼ en una serie prospectiva de sujetos sometidos a compensación laboral. MATERIAL Y MÉTODOS: cohorte prospectiva de 54 hombros con tenodesis «relajada¼ con tornillo interferencial intraarticular, mismo cirujano, Octubre de 2014 a 2018, centro de trauma nivel 1. Se analizaron datos demográficos, resultados clínicos, funcionales y radiográficos. A los seis meses se realizó una ecografía de control y se evaluaron complicaciones. RESULTADOS: edad media 49 ± 9 años, seguimiento promedio 16 ± 4 meses. El diagnóstico primario fue rotura del manguito rotador en 79%, patología primaria del bíceps en 10% y otras patologías en 11%. Al término del seguimiento, la elevación anterior activa fue 157.7 ± 22.7, rotación externa 47 ± 16.6, rotación interna mediana T12, Constant Score 83 ± 12.05 puntos, valoración subjetiva del hombro 83 ± 12.97% y escala visual análoga del dolor 1.4 ± 1.7 puntos. Un paciente sufrió una rotura del bíceps y dos casos una asimetría estética del brazo. En ecografía, en 98% se visualizó el TCLB in situ y en 10% se objetivaron cambios inflamatorios en la corredera bicipital. Reportamos 21% de complicaciones. CONCLUSIONES: la tenodesis «relajada¼ presenta resultados clínicos, funcionales e imagenológicos satisfactorios, con baja tasa de fallo.

Stenocereus huastecorum-fruit juice concentrate protects against cisplatin-induced nephrotoxicity by nitric oxide pathway activity and antioxidant and antiapoptotic effects.

Cisplatin (CP) is an antineoplastic agent used to treat solid tumors, that has high nephrotoxicity caused by physiologic, hemodynamic, and biochemical alterations. Some studies have shown that naturally derived bioactive compounds in CP-induced nephrotoxicity reduce the side effects of this antineoplastic drug. Pitaya is an endemic fruit from Mexico with a high bioactive compound content, including betalains and phenolic compounds, with reports of antioxidant and anti-inflammatory properties. In this study, the aim was to establish the effect of a pitaya juice concentrate (PJC) on CP-induced nephrotoxicity in Wistar male rats through the identification of metabolites, determination of its chemical composition and antioxidant activity, and evaluation of the protective effect of a PJC on CP-induced nephrotoxicity in rats. The PJC showed a high content of betanins with antioxidant activity by an oxygen radical absorbance capacity assay (1299.6 ± 2.80 Trolox equivalents/g). PJC was administered daily (400 mg day-1, p. o.) for 3 days before CP administration until the end of the experiment. On day four, rats were administered a single injection of CP (6 mg kg, i.p.-1) and sacrificed 72 h later. We observed that CP provoked renal dysfunction (1.0 ± 0.1 vs. 0.4 ± 0.07 serum creatinine levels), oxidative stress, a decrease in nitrate and nitrite (NO2¯/NO3¯) levels (0.1 ± 0.08 vs. 0.4 ± 0.3) and activation of apoptosis and immune responses in kidney tissue. In addition, CP treatment induced tubular damage threefold. PJC administration prevented renal dysfunction (0.5 ± 0.06 vs. 1.0 ± 0.1), normalized degenerative structural damage prevented the increase in lipoperoxidation levels (0.04 ± 0.01 vs. 0.2 ± 0.1) and reduced the apoptosis index by 2.5 in kidney tissue. However, it did not modify the immune response caused by CP. Furthermore, PJC treatment increased nuclear factor erythroid two related factors two protein levels two times and NO2¯/NO3¯ levels 22 times in kidney tissue, which may play a role in the renoprotective effect. In conclusion, the renoprotective effect of PJC on CP-induced nephrotoxicity was associated with the attenuation of dysfunction, structural damage, apoptosis activation, and oxidative stress and was related to changes in the tumor necrosis factor-alpha and renal nitric oxide (NO) pathways. The changes in the NO pathway may be involved in renal hemodynamics. Pitaya could be used as a functional food and therapeutic coadjuvant during CP treatments due to its high bioactive levels and renoprotective compounds.

Correlation between femoral version and severity of hip dysplasia in patients with advanced osteoarthritis prior to total hip arthroplasty. / Correlación entre versión femoral y gravedad de displasia del desarrollo de cadera en pacientes con artrosis avanzada.

INTRODUCTION: Developmental dysplasia of the hip (DDH) is a condition which comprises a number of joint abnormalities, including modifications in femoral version and neck-shaft angle (CCD), as well as a probable progression to osteoarthritis in certain cases. The main objective of this research was to find a correlation between femoral version and severity of DDH in patients with advanced osteoarthritis prior to joint replacement, which has not been previously reported. A secondary aim was to describe the modification of CCD as the severity of DDH increases. MATERIALS AND METHOD: Patients over the age of 15 with dysplastic hips and severe osteoarthritis prior to total hip arthroplasty were assessed between March 2018 and February 2019. Cases with any previous hip surgery were excluded. Anteroposterior pelvis X rays and femoral computed tomography (CT) were performed; femoral version was measured in CT and CCD was evaluated both in X rays (2 observers: A and B) and CT (one observer: musculoskeletal radiologist). Severity of DDH was defined by observers A and B according to Crowe classification in X rays. Statistical analysis was performed on SPSS v.21. Shapiro-Wilk test was used to confirm a normal data distribution. Intraclass correlation coefficient (ICC) determined the level of agreement between observers A and B. Pearson test assessed the correlation between femoral version and Crowe classification (positive if >0.5). Student's t test evaluated the statistical significance, which was defined as P<0.05. RESULTS: One-year assessment; 42 patients (54 hips), 76% women. Mean age 52.7 years. 45 hips completed the imaging set, 9 hips were assessed only with X rays. 48%, 16%, 7% and 28% were classified as Crowe I, II, III and IV (100% interobserver agreement). Crowe classes were grouped as I, II/III and IV due to a low number of cases classified as II and III. Mean femoral version was 21.73°, 26.8° and 43.58°, respectively. ICC between observers A and B for CCD measured in X rays was 0.96. Mean CCD measured in X rays for each group (I, II/III and IV) was 148.11°, 147.7° and 147°, and in CT was 131.21°, 127.9° and 122.14°, respectively. A significant difference was found in femoral version between groups I and IV (P=0.0002) and II/III and IV (P=0.042). Pearson correlation between femoral version and severity of DDH was positive (r=0.52; P=0.0002). A significant difference between CCD measured in CT was found between groups I and IV (P=0.003). CONCLUSIONS: A significant increase in femoral version related to severity of DDH and a positive correlation between these 2features were found. Furthermore, a significant decrease in CCD between groups I and IV measured in CT was revealed. These findings would be helpful for preoperative planning of total hip replacement in osteoarthritis secondary to DDH, because once the surgeon has assessed the severity of DDH on X rays or CT, an increased femoral version could be expected. Therefore, availability of specific implants such as conic, modular or cemented stems is critical, in order to modify the femoral anteversion to normal values in the most severe cases.

Correlación entre versión femoral y gravedad de displasia del desarrollo de cadera en pacientes con artrosis avanzada / Correlation between femoral version and severity of hip dysplasia in patients with advanced osteoarthritis prior to total hip arthroplasty

Antecedentes y objetivo: La displasia del desarrollo de cadera (DDC) es una dolencia que incluye un gran espectro de manifestaciones articulares, tales como alteraciones en la versión femoral y en el ángulo cérvico-diafisiario (ACD), así como una probable progresión a artrosis. El objetivo de este estudio fue buscar una correlación entre la versión femoral y la gravedad de la DDC en pacientes con artrosis. Otro objetivo planteado fue evaluar si se presentan cambios significativos en el valor del ACD a medida que la gravedad de la DDC aumenta. Materiales y método: Entre marzo de 2018 y febrero de 2019 fueron evaluados pacientes mayores de 15 años con DDC, sin cirugías de cadera previas y artrosis grave de cadera en espera de artroplastia total. Se solicitaron radiografías (Rx) de pelvis (anteroposterior) y de cadera (anteroposterior y lateral), así como tomografías axiales computadas (TAC) de cadera y rodilla de las extremidades afectadas, en las cuales se realizó la medición de versión femoral y ACD.La clasificación de Crowe fue utilizada para categorizar la gravedad de la DDC y, al igual que el ACD, fue evaluada en forma independiente por 2observadores. La versión femoral y el ACD en la TAC fueron medidos por un radiólogo especialista en enfermedad musculoesquelética. El análisis estadístico fue realizado con SPSS v. 21. Se consideró un valor significativo de p<0,05. Resultados: Los 42 pacientes que cumplieron los criterios de inclusión asistieron a la evaluación; el 76% era de género femenino, con una edad promedio de 52,7 años. De un total de 54 caderas afectadas, 45 fueron evaluadas con ambos exámenes (Rx y TAC) y 9caderas solo con Rx (uno de ellos falleció por otras causas antes de la TAC). El 48%; 16%; 7% y el 28% de las caderas fueron clasificadas en la Rx como Crowe I, II, III y IV, respectivamente, con una concordancia interobservador del 100%.(AU)

Introduction: Developmental dysplasia of the hip (DDH) is a condition which comprises a number of joint abnormalities, including modifications in femoral version and neck-shaft angle (CCD), as well as a probable progression to osteoarthritis in certain cases. The main objective of this research was to find a correlation between femoral version and severity of DDH in patients with advanced osteoarthritis prior to joint replacement, which has not been previously reported. A secondary aim was to describe the modification of CCD as the severity of DDH increases. Materials and method: Patients over the age of 15 with dysplastic hips and severe osteoarthritis prior to total hip arthroplasty were assessed between March 2018 and February 2019. Cases with any previous hip surgery were excluded. Anteroposterior pelvis X rays and femoral computed tomography (CT) were performed; femoral version was measured in CT and CCD was evaluated both in X rays (2 observers: A and B) and CT (one observer: musculoskeletal radiologist). Severity of DDH was defined by observers A and B according to Crowe classification in X rays. Statistical analysis was performed on SPSS v.21. Shapiro-Wilk test was used to confirm a normal data distribution. Intraclass correlation coefficient (ICC) determined the level of agreement between observers A and B. Pearson test assessed the correlation between femoral version and Crowe classification (positive if >0.5). Student's t test evaluated the statistical significance, which was defined as P<0.05. Results: One-year assessment; 42 patients (54 hips), 76% women. Mean age 52.7 years. 45 hips completed the imaging set, 9 hips were assessed only with X rays. 48%, 16%, 7% and 28% were classified as Crowe I, II, III and IV (100% interobserver agreement). Crowe classes were grouped as I, II/III and IV due to a low number of cases classified as II and III. Mean femoral version was 21.73°, 26.8° and 43.58°, respectively. (AU)

Correlation between femoral version and severity of hip dysplasia in patients with advanced osteoarthritis prior to total hip arthroplasty / Correlación entre versión femoral y gravedad de displasia del desarrollo de cadera en pacientes con artrosis avanzadaS

Introduction: Developmental dysplasia of the hip (DDH) is a condition which comprises a number of joint abnormalities, including modifications in femoral version and neck-shaft angle (CCD), as well as a probable progression to osteoarthritis in certain cases. The main objective of this research was to find a correlation between femoral version and severity of DDH in patients with advanced osteoarthritis prior to joint replacement, which has not been previously reported. A secondary aim was to describe the modification of CCD as the severity of DDH increases. Materials and method: Patients over the age of 15 with dysplastic hips and severe osteoarthritis prior to total hip arthroplasty were assessed between March 2018 and February 2019. Cases with any previous hip surgery were excluded. Anteroposterior pelvis X rays and femoral computed tomography (CT) were performed; femoral version was measured in CT and CCD was evaluated both in X rays (2 observers: A and B) and CT (one observer: musculoskeletal radiologist). Severity of DDH was defined by observers A and B according to Crowe classification in X rays. Statistical analysis was performed on SPSS v.21. Shapiro-Wilk test was used to confirm a normal data distribution. Intraclass correlation coefficient (ICC) determined the level of agreement between observers A and B. Pearson test assessed the correlation between femoral version and Crowe classification (positive if >0.5). Student's t test evaluated the statistical significance, which was defined as P<0.05. Results: One-year assessment; 42 patients (54 hips), 76% women. Mean age 52.7 years. 45 hips completed the imaging set, 9 hips were assessed only with X rays. 48%, 16%, 7% and 28% were classified as Crowe I, II, III and IV (100% interobserver agreement). Crowe classes were grouped as I, II/III and IV due to a low number of cases classified as II and III. Mean femoral version was 21.73°, 26.8° and 43.58°, respectively. (AU)

Antecedentes y objetivo: La displasia del desarrollo de cadera (DDC) es una dolencia que incluye un gran espectro de manifestaciones articulares, tales como alteraciones en la versión femoral y en el ángulo cérvico-diafisiario (ACD), así como una probable progresión a artrosis. El objetivo de este estudio fue buscar una correlación entre la versión femoral y la gravedad de la DDC en pacientes con artrosis. Otro objetivo planteado fue evaluar si se presentan cambios significativos en el valor del ACD a medida que la gravedad de la DDC aumenta. Materiales y método: Entre marzo de 2018 y febrero de 2019 fueron evaluados pacientes mayores de 15 años con DDC, sin cirugías de cadera previas y artrosis grave de cadera en espera de artroplastia total. Se solicitaron radiografías (Rx) de pelvis (anteroposterior) y de cadera (anteroposterior y lateral), así como tomografías axiales computadas (TAC) de cadera y rodilla de las extremidades afectadas, en las cuales se realizó la medición de versión femoral y ACD.La clasificación de Crowe fue utilizada para categorizar la gravedad de la DDC y, al igual que el ACD, fue evaluada en forma independiente por 2observadores. La versión femoral y el ACD en la TAC fueron medidos por un radiólogo especialista en enfermedad musculoesquelética. El análisis estadístico fue realizado con SPSS v. 21. Se consideró un valor significativo de p<0,05. Resultados: Los 42 pacientes que cumplieron los criterios de inclusión asistieron a la evaluación; el 76% era de género femenino, con una edad promedio de 52,7 años. De un total de 54 caderas afectadas, 45 fueron evaluadas con ambos exámenes (Rx y TAC) y 9caderas solo con Rx (uno de ellos falleció por otras causas antes de la TAC). El 48%; 16%; 7% y el 28% de las caderas fueron clasificadas en la Rx como Crowe I, II, III y IV, respectivamente, con una concordancia interobservador del 100%.(AU)

Reparación laparoscópica de la hernia inguinal en Cirugía Mayor Ambulatoria: es el momento / Laparoscopic inguinal hernia repair in major outpatient surgery: The time is now

Introducción: El abordaje laparoscópico de la hernia inguinal en el contexto de Cirugía Mayor Ambulatoria (CMA) se encuentra en constante discusión, entre otras razones por la curva de aprendizaje que entraña. El objetivo del presente estudio es presentar nuestros resultados iniciales en el abordaje laparoscópico de la hernia inguinal en régimen de CMA.Pacientes y métodos: Cohorte retrospectiva de los pacientes intervenidos de hernia inguinal mediante abordaje laparoscópico por el mismo grupo quirúrgico en curva de aprendizaje desde febrero de 2020 hasta agosto de 2021.Resultados: Se intervinieron 100 hernias inguinales vía laparoscópica. Las técnicas quirúrgicas empleadas fueron 98 % TEP y 2 % TAPP. La tasa de conversión fue nula. El tiempo quirúrgico fue de 44 ± 10 min. EVA score primer día postoperatorio de 3,72, séptimo día 2,73, primer mes 1,65, sexto mes 0,43 y al año 0,47. La tasa de recurrencia al año fue del 2,4 %.Conclusión: El abordaje laparoscópico puede ser aprendido de forma fácil y segura cuando se utiliza una técnica estandarizada y supervisada en los primeros casos por expertos, siendo ideal su uso en régimen de CMA. (AU)

Introduction: Within the scope of Ambulatory Major Surgery (AMS), the laparoscopic approach for inguinal hernia repair is often under discussion, especially due to its peculiar learning curve. The aim of this study is to show our first results after the treatment of laparoscopic approach for inguinal hernia in MOS. Materials and methods: Retrospective cohort study of undergone inguinal hernia patients by Laparoscopic approach and the same surgical group in the learning curve from February 2020 to August 2021.Results: It was operated a total of 100 inguinal hernias by laparoscopy and the surgical techniques used were 98 % TEP y 2 % TAPP. The conversion rate was zero. Operative time was 44 ± 10 min. First postoperative day VAS score was 3.72, seventh day was 2.73, first month 1.65, sixth month 0.43 and 0.47 at one year. The rate of recurrence at one year was 2,4 %.Conclusion: The laparoscopic approach can be learned in a safe and easy way using a standardised technique and, in the first cases, under the supervision of experts. Its use is ideal for AMS cases. (AU)

Tumores fibroóseos de cavidades paranasales: experiencia en el Hospital Clínico de la Universidad de Chile y revisión de la literatura / Fibro-osseous tumors of paranasal cavities: experience in the Hospital Clínico de la Universidad de Chile and review of the literature

Los tumores de cavidades paranasales presentan una baja frecuencia. Dentro de éstos, entre los benignos destacan las lesiones fibroóseas que se caracterizan por el reemplazo de hueso normal por estroma celular fibroso. Dentro de estas lesiones se describen osteoma, displasia fibrosa y fibroma osificante. Se revisan 3 casos de pacientes del Hospital Clínico de la Universidad de Chile y se presenta una revisión bibliográfica en cuanto a las lesiones fibroóseas, su clínica, diagnóstico, imagenología y tratamiento.

The tumors of paranasal cavities present a low frequency. Among the benign tumors are fibro-osseous lesions characterized by the replacement of normal bone by fibrous cell stroma. Osteoma, fibrous dysplasia, and ossifying fibroma are described within these lesions. Three cases of patients from the Hospital Clínico de la Universidad de Chile are reviewed and a bibliographic review is presented regarding the fibro-osseous lesions, their clinical features, diagnosis, imaging and treatment.

A qPCR Targeted Against the Viral Replication Origin Designed to Quantify Total Amount of Filamentous Phages and Phagemids.

Filamentous bacteriophages are widely used in phage display technology. The most common quantification method is lysis plaque formation test (PFT). This technique has several disadvantages, and only quantifies infective phages and is not effective when phagemids are used. We developed a qPCR method directed against the M13 replication origin, which detects between 3.3 × 103 and 3.3 × 108 viral genome copies with a linearity of R 2 = 0.9998. Using this method we were able to observe a difference of approximately ten more phages than with the PFT. This difference was not due to the presence of a free genome, which suggests the presence of non-infective particles. Using a DNaseI treatment, we observed the presence of 30% to 40% of unpackaged genome in recombinant phage modified in PIII or PVIII. The qPCR method with a DNase I treatment is an efficient method to quantify the total amount of filamentous phages.

Self-organization and energy of superparamagnetic nets.

Superparamagnetic filaments assemble, building one-layered aggregates due to the screening effect inherited from the dipole interaction potential in a colloidal blend. The magnetic energy of rectangular and irregular ribbons is computed to obtain their mean length at thermodynamic equilibrium, in good agreement with experimental measurements.

[Prevalence of obesity and arterial hypertension and their relationship with age and gender in the city of Resistencia, Argentina, in the years 2008-2014]. / Prevalencia de obesidad e hipertensión arterial y su asociación con edad y sexo en la ciudad de Resistencia (Argentina), años 2008-2014.

INTRODUCTION: Obesity (OB) is a global pandemic, which is associated with arterial hypertension (AH). The differences in this relationship according to gender and age remain unclear. The objectives of this study were to establish the prevalence of OB and AH in an adult population, and to determine the risk of AH associated with OB in relationship to gender and age. MATERIAL AND METHODS: A cross-sectional study was performed using the database of successive cross-sectional studies carried out in 5 city squares in Resistencia (Argentina) during the years 2008-2014. The sample was randomised according to gender and age, according to the distribution of the last National Argentine Census. RESULTS: A total of 7,898 passers-by (46.8% males) with a mean age 42.74 ± 16.70 years were included. OB in men increased from 21.3% to 26.9%, and in women from 15.2% to 23%, the former having the highest prevalence between 40-49 years, and the latter between 50-59 years, and thereafter it was always higher in women. AH increased in men from 39.9% to 42.7%, and in women from 25.8% to 29.2%, the former having the highest prevalence between 60-69 years, the latter between 70-79 years. CONCLUSION: In the 7 years of the study, OB and AH prevalence increased. It was higher in men, although the risk of developing AH associated with OB was greater in older women. The highest prevalence of OB and AH appears a decade earlier in men.

Estudio cualitativo de la práctica fonoaudiológica en el contexto de rehabilitación basada en la comunidad, en la Quinta Región de Valparaíso / Community based speech and language rehabilitation qualitative study, in the fifth Region of Valparaíso

El enfoque de Rehabilitación Basada en la Comunidad (RBC) representa una estrategia cuyo propósito es lograr la plena integración e inclusión de las personas en situación de discapacidad (PsSD) a nivel social. Considerando que la comunicación y el lenguaje humano representan herramientas de expresión del pensamiento, la Asociación Americana de Habla, Lenguaje y Audición (ASHA) insta a promover el desarrollo de una comunicación efectiva como un derecho humano accesible para todas las personas, en consideración de su dignidad inherente. OBJETIVO: conocer el quehacer de fonoaudiólogos(as) que se desempeñan en el contexto de RBC, en la Quinta Región de Valparaíso. MÉTODO: investigación de tipo cualitativa, con enfoque fenomenológico. Se realizó una entrevista semiestructurada y posteriormente se procedió a realizar un análisis de contenido. RESULTADOS: Los fonoaudiólogos(as) ejecutan acciones atingentes a los cinco pilares de la RBC y se observa la práctica de actos vinculados a la gestión del intersector. CONCLUSIONES: Los profesionales adoptan la estrategia RBC incorporada en la visión de la institución en la que se encuentran insertos, adoptando un perfil orientado a la transdisciplina.

The Community Based Rehabilitation (CBR) approach represents a strategy whose purpose is to achieve full social integration and inclu sion of people with disabilities. Considering that communication and human language represent tools of expression of thought, the American Speech, Language and Hearing Association (ASHA) advo cates the development of effective communication promotion, as a human right accessible to all people, considering its inherent dignity. OBJECTIVE: to analyze speech and language pathologist's CBR prac tices in the fifth region of Valparaíso. METHOD: qualitative research, with a phenomenological approach. A semi-structured interview was conducted followed by a content analysis. RESULTS: speech and Language pathologists carry out actions related to the five CBR key components and also the practice of actions in accord to intersector. CONCLUSIONS: The professionals adopt the CBR approach incorporat ing the institutional vision of service in which they are inserted and adopting a profile oriented to transdisciplinary.

Effect of watershed land use on water quality: a case study in Córrego da Olaria Basin, São Paulo State, Brazil / Efeito do uso do solo em sub-bacias na qualidade da água: um estudo de caso na Bacia do Córrego da Olaria, Estado de São Paulo, Brasil

Abstract The water quality is related to the hydrologic and limnologic properties of ground and surface water, and significant efforts have been made to monitor water sources to understand the effects of land use changes in agricultural areas, with significant socioeconomic activities. The objective of this study was to evaluate the qualitative aspects of surface water in subbasins related to land use. Samples were analyzed in terms of physical and chemical parameters on monthly discrete water quality sampling in four representative sites at first order subbasin streams, located at the Polo Regional Centro Norte, Pindorama County, State of São Paulo, Brazil. The land use classification was made by visual detection technique in a multispectral satellite data obtained from LandSat8- spectral bands of the OLI sensor. The watershed was classified into major land cover/use classes and overlay maps generated in ArcGIS 10 indicated a significant shift from natural vegetation to agriculture activities. Water quality monitoring was according to the brazilian protocol and the results were submitted to analysis of variance (ANOVA). The values obtained differ significantly at each sampling point - subbasins, reflecting the effects of land use on water quality. Soil conservation management is important to optimize soil use in order to contribute to the control of water pollution and the formulation of a public policy is necessary for the conservation of water and soil resources.

Resumo A qualidade da água está relacionada com as propriedades hidrológicas e limnológicas das águas subterrâneas e superficiais, e esforços significativos devem ser realizados para monitorar as nascentes no intuito de compreender os efeitos das mudanças no uso da terra em áreas agrícolas, com atividades socioeconômicas significativas. O objetivo deste estudo foi avaliar os aspectos qualitativos das águas superficiais de bacias hidrográficas e correlacionar com o uso do solo. As amostras foram analisadas em termos dos parâmetros físicos e químicos na amostragem mensal discreta da qualidade da água, em quatro locais representativos de nascentes em microbacias de primeira ordem, localizadas no Polo Regional Centro Norte, Pindorama, Estado de São Paulo, Brasil. A classificação do uso do solo foi feita por técnica de detecção visual em uma imagem multiespectral de satélite LandSat8- bandas espectrais, sensor OLI. O uso do solo foi classificado nas principais classes de uso e os mapas de sobreposição gerados no ArcGIS 10 indicaram uma mudança significativa da vegetação natural para as atividades agrícolas. O monitoramento da qualidade da água foi realizado de acordo com o protocolo brasileiro e os resultados foram submetidos à análise de variância (ANOVA). Os valores obtidos diferem significativamente em cada ponto de amostragem, refletindo os efeitos do uso do solo sobre a qualidade da água. A gestão do solo e da água é importante para aperfeiçoar as práticas agrícolas, no intuito de contribuir para o controle da poluição da água e para a formulação de uma política pública necessária para a conservação dos recursos hídricos e do solo.

Effect of watershed land use on water quality: a case study in Córrego da Olaria Basin, São Paulo State, Brazil.

The water quality is related to the hydrologic and limnologic properties of ground and surface water, and significant efforts have been made to monitor water sources to understand the effects of land use changes in agricultural areas, with significant socioeconomic activities. The objective of this study was to evaluate the qualitative aspects of surface water in subbasins related to land use. Samples were analyzed in terms of physical and chemical parameters on monthly discrete water quality sampling in four representative sites at first order subbasin streams, located at the Polo Regional Centro Norte, Pindorama County, State of São Paulo, Brazil. The land use classification was made by visual detection technique in a multispectral satellite data obtained from LandSat8- spectral bands of the OLI sensor. The watershed was classified into major land cover/use classes and overlay maps generated in ArcGIS 10 indicated a significant shift from natural vegetation to agriculture activities. Water quality monitoring was according to the brazilian protocol and the results were submitted to analysis of variance (ANOVA). The values obtained differ significantly at each sampling point - subbasins, reflecting the effects of land use on water quality. Soil conservation management is important to optimize soil use in order to contribute to the control of water pollution and the formulation of a public policy is necessary for the conservation of water and soil resources.

Self-assembly processes of superparamagnetic colloids in a quasi-two-dimensional system.

Superparamagnetic colloids gather depending on the magnitude of the magnetic field applied, forming chains and ribbons in a quasi-two-dimensional chamber. The results presented in this work are in good agreement with recent experimental multistable data for the mean length of the aggregates in thermodynamic equilibrium.

Effect of watershed land use on water quality: a case study in Córrego da Olaria Basin, São Paulo State, Brazil

Abstract The water quality is related to the hydrologic and limnologic properties of ground and surface water, and significant efforts have been made to monitor water sources to understand the effects of land use changes in agricultural areas, with significant socioeconomic activities. The objective of this study was to evaluate the qualitative aspects of surface water in subbasins related to land use. Samples were analyzed in terms of physical and chemical parameters on monthly discrete water quality sampling in four representative sites at first order subbasin streams, located at the Polo Regional Centro Norte, Pindorama County, State of São Paulo, Brazil. The land use classification was made by visual detection technique in a multispectral satellite data obtained from LandSat8- spectral bands of the OLI sensor. The watershed was classified into major land cover/use classes and overlay maps generated in ArcGIS 10 indicated a significant shift from natural vegetation to agriculture activities. Water quality monitoring was according to the brazilian protocol and the results were submitted to analysis of variance (ANOVA). The values obtained differ significantly at each sampling point - subbasins, reflecting the effects of land use on water quality. Soil conservation management is important to optimize soil use in order to contribute to the control of water pollution and the formulation of a public policy is necessary for the conservation of water and soil resources.

Resumo A qualidade da água está relacionada com as propriedades hidrológicas e limnológicas das águas subterrâneas e superficiais, e esforços significativos devem ser realizados para monitorar as nascentes no intuito de compreender os efeitos das mudanças no uso da terra em áreas agrícolas, com atividades socioeconômicas significativas. O objetivo deste estudo foi avaliar os aspectos qualitativos das águas superficiais de bacias hidrográficas e correlacionar com o uso do solo. As amostras foram analisadas em termos dos parâmetros físicos e químicos na amostragem mensal discreta da qualidade da água, em quatro locais representativos de nascentes em microbacias de primeira ordem, localizadas no Polo Regional Centro Norte, Pindorama, Estado de São Paulo, Brasil. A classificação do uso do solo foi feita por técnica de detecção visual em uma imagem multiespectral de satélite LandSat8- bandas espectrais, sensor OLI. O uso do solo foi classificado nas principais classes de uso e os mapas de sobreposição gerados no ArcGIS 10 indicaram uma mudança significativa da vegetação natural para as atividades agrícolas. O monitoramento da qualidade da água foi realizado de acordo com o protocolo brasileiro e os resultados foram submetidos à análise de variância (ANOVA). Os valores obtidos diferem significativamente em cada ponto de amostragem, refletindo os efeitos do uso do solo sobre a qualidade da água. A gestão do solo e da água é importante para aperfeiçoar as práticas agrícolas, no intuito de contribuir para o controle da poluição da água e para a formulação de uma política pública necessária para a conservação dos recursos hídricos e do solo.

The fern cavitation catapult: mechanism and design principles.

Leptosporangiate ferns have evolved an ingenious cavitation catapult to disperse their spores. The mechanism relies almost entirely on the annulus, a row of 12-25 cells, which successively: (i) stores energy by evaporation of the cells' content, (ii) triggers the catapult by internal cavitation, and (iii) controls the time scales of energy release to ensure efficient spore ejection. The confluence of these three biomechanical functions within the confines of a single structure suggests a level of sophistication that goes beyond most man-made devices where specific structures or parts rarely serve more than one function. Here, we study in detail the three phases of spore ejection in the sporangia of the fern Polypodium aureum. For each of these phases, we have written the governing equations and measured the key parameters. For the opening of the sporangium, we show that the structural design of the annulus is particularly well suited to inducing bending deformations in response to osmotic volume changes. Moreover, the measured parameters for the osmoelastic design lead to a near-optimal speed of spore ejection (approx. 10 m s(-1)). Our analysis of the trigger mechanism by cavitation points to a critical cavitation pressure of approximately -100 ± 14 bar, a value that matches the most negative pressures recorded in the xylem of plants. Finally, using high-speed imaging, we elucidated the physics leading to the sharp separation of time scales (30 versus 5000 µs) in the closing dynamics. Our results highlight the importance of the precise tuning of the parameters without which the function of the leptosporangium as a catapult would be severely compromised.

Comparative efficacy of fixed-dose combinations of long-acting muscarinic antagonists and long-acting ß2-agonists: a systematic review and network meta-analysis.

BACKGROUND: A number of long-acting muscarinic antagonist (LAMA)/long-acting ß2-agonist (LABA) fixed-dose combinations (FDCs) for treatment of moderate-to-very severe chronic obstructive pulmonary disease (COPD) have recently become available, but none have been directly compared in head-to-head randomized controlled trials (RCTs). The purpose of this study was to assess the relative clinical benefit of all currently available LAMA/LABA FDCs using a Bayesian network meta-analysis (NMA). METHODS: A systematic literature review identified RCTs investigating the efficacy, safety and quality of life associated with licensed LAMA/LABA FDCs for the treatment of moderate-to-very severe COPD. RCTs were screened for inclusion in the NMA using prespecified eligibility criteria. Data were extracted for outcomes of interest, including change in trough forced expiratory volume in 1 second (tFEV1) from baseline, St. George Respiratory Questionnaire (SGRQ) percentage of responders, Transition Dyspnea Index (TDI) percentage of responders, change in SGRQ score from baseline, change in TDI focal score from baseline, moderate-to-severe exacerbations, all-cause discontinuation, and discontinuation due to adverse events. RESULTS: Following screening, a total of 27 trials from 26 publications with 30,361 subjects were eligible for inclusion in the NMA. Nonsignificant results were seen in most analyses comparing efficacy, exacerbations and discontinuation rates of included LAMA/LABA FDCs (i.e. aclidinium/formoterol 400/12 µg, glycopyrronium/indacaterol 110/50 µg, tiotropium + olodaterol 5/5 µg, umeclidinium/vilanterol 62.5/25 µg). Meta-regression controlling for post-bronchodilator percentage of tFEV1 predicted at baseline as well as meta-regression adjusting for concomitant use of inhaled corticosteroids at baseline was performed to assess the magnitude of effect modification and produced similar results as observed in the base case analysis. CONCLUSION: All LAMA/LABA FDCs were found to have similar efficacy and safety. Definitive assessment of the relative efficacy of different treatments can only be performed through direct comparison in head-to-head RCTs. In the absence of such data, this indirect comparison may be of value in clinical and health economic decision-making.

Dermal toxicity, eye and dermal irritation and skin sensitization evaluation of a new formulation of Bacillus thuringiensis var israelensis SH-14.

Bacillus thuringiensis (Bt) is the best known and most widely used of all pesticidal microbes. The aim of this study was to assess the toxicity of a new formulation of Bacillus thuringiensis var israelensis SH-14 in rats through acute dermal toxicity, dermal and eye irritation experiments. The acute dermal toxicity and dermal and eye irritation studies were performed using rabbits according to the United States Environmental Protection Agency guidelines 885.3100, 870.2500 and 870.2500, respectively. The skin sensitization study was carried out in accordance to the EPA OPPTS 870.2600 using guinea pigs. There was no mortality and no evidence of treatment-related toxicity in acute dermal toxicity test. No dermal responses, including erythema/eschar or edema, were found in rabbits treated with the new formulation of Bti SH-14. Minimum response was observed after eye application of test substance. No skin sensitization reactions were observed after the challenge with the new formulation of Bti SH-14 in the Bti SH-14-treated guinea pigs. In summary, the present study demonstrated that the new formulation of Bti SH-14 is not acutely toxic via dermal route, has low eye irritation and would not cause dermal irritation or hypersensitivity to tested animals.

Rol de anticuerpos anti- Toxoplasma gondii en la activación de la respuesta inmune en mujeres embarazadas / Role of anti-Toxoplasma gondii antibodies in immune responses in pregnant women

Objetivos: el estudio tuvo como objetivo evaluar in vitro el rol de anticuerpos anti T. gondii en la activación de la respuesta inmune en mujeres embarazadas. Métodos: el estudio se realizó con células mononucleares de sangre periférica (PBMC) de mujeres embarazadas con toxoplasmosis crónica (n=15) que fueron estimuladas en presencia y ausencia de plasma autólogo (PA) (anticuerpos anti T. gondii). Resultados: los datos muestran que en PBMC estimuladas en ausencia de plasma autólogo existe mayor proliferación celular (P<0.05) que células en presencia de plasma autólogo. Niveles de IFN-y producidos en ambas condiciones (PA y SBF) fueron similares. Comparando la producción de IFN-y vs IL-10 muestra mayor producción de citoquinas Th1. Conclusiones: en general nuestros resultados sugieren que los anticuerpos presentes en el plasma autólogo modulan la respuesta inmune en mujeres embarazadas con toxoplasmosis crónica, de tal modo que el sistema inmune no exacerbe o inhiba esta respuesta específica. La presencia de anticuerpos anti T. gondii no influyen en producción de IFN-y en mujeres embarazadas con toxoplasmosis crónica, pero si en la proliferación celular.

Objectives: the study aimed to evaluate in vitro the role of anti T. gondiiin activating immune responses in pregnant women. Methods: the study was performed with peripheral blood mononuclear cells (PBMC) of pregnant women with chronic toxoplasmosis (n = 15) were stimulated in the presence and absence of autologous plasma (PA) (anti T. gondii antibody). Results: the data show that in PBMC stimu-lated in the absence of autologous plasma there is increased cell proliferation (P < 0.05) than cells in the presence of autologous plasma. Levels of IFN- y produced in both conditions (PA and SBF) were similar. Comparing the production of IFN- y vs IL - 10 shows increased production of Th1 cytokines. Conclusions: in general, our results suggest that the antibodies present in autologous plasma modulate the immune response in pregnant women with chronic toxoplasmosis, such that the immune system does not exacerbate or inhibit this specific response. The presence of antibodies to T. gondii not affecting IFN- y production in pregnant women with chronic toxoplasmosis, but if cell proliferation.