Mercury Pollution History in Tropical and Subtropical American Lakes: Multiple Impacts and the Possible Relationship with Climate Change.

Sediment cores obtained from 11 tropical and subtropical American lakes revealed that local human activities significantly increased mercury (Hg) inputs and pollution levels. Remote lakes also have been contaminated by anthropogenic Hg through atmospheric depositions. Long-term sediment-core profiles revealed an approximately 3-fold increase in Hg fluxes to sediments from c. 1850 to 2000. Generalized additive models indicate that c. 3-fold increases in Hg fluxes also occurred since 2000 in the remote sites, while Hg emissions from anthropogenic sources have remained relatively stable. The tropical and subtropical Americas are vulnerable to extreme weather events. Air temperatures in this region have shown a marked increase since the 1990s, and extreme weather events arising from climate change have increased. When comparing Hg fluxes to recent (1950-2016) climatic changes, results show marked increases in Hg fluxes to sediments during dry periods. The Standardized Precipitation-Evapotranspiration Index (SPEI) time series indicate a tendency toward more extreme drier conditions across the study region since the mid-1990s, suggesting that instabilities in catchment surfaces caused by climate change are responsible for the elevated Hg flux rates. Drier conditions since c. 2000 appear to be promoting Hg fluxes from catchments to lakes, a process that will likely be exacerbated under future climate-change scenarios.

Efecto de la pandemia en la cirugía radical del cáncer vesical / Effect of the pandemic on radical surgery for bladder cancer

Objetivo: El advenimiento de la pandemia de síndrome respiratorio agudo por coronavirus 2 (SARS-CoV-2) ha tenido un impacto en el manejo del resto de las patologías por la elevada presión asistencial generada. Por su historia natural, el cáncer vesical susceptible de cistectomía radical (CR) requiere especial atención. Nuestro objetivo es comparar los resultados perioperatorios y oncológicos de estos pacientes durante el estado de alarma respecto a la era pre-COVID en un centro de tercer nivel. Material y métodos: Estudio retrospectivo observacional descriptivo y analítico. Pacientes intervenidos de cistectomía radical por neoplasia entre abril de 2019 y marzo de 2021 divididos en dos grupos, abril 2019-marzo 2020 (n = 42) y abril 2020-marzo 2021 (n = 43). Resultados: Ambos grupos resultaron ser homogéneos. La mediana de espera desde la resección transuretral de vejiga hasta la realización de la CR no aumentó (82,5 vs. 83 días, p = = 0,860). No se observan tampoco diferencias en la estadificación TNM de las piezas quirúrgicas. Los tumores localmente avanzados no aumentaron significativamente (18 vs. 21, p = 0,580). La presencia de afectación ganglionar tampoco presentó diferencias significativas (10 vs. 13, p = 0,675). La estancia media disminuyó en un valor cercano a significación (mediana en días: 11 vs. 8, p = 0,056) sin que ello asociase un mayor número de complicaciones o de reingresos a los 30 días. Conclusión:: En nuestra serie no hemos constatado diferencias significativas en los resultados perioperatorios y oncológicos de pacientes tratados mediante CR durante la pandemia de COVID-19.

Introduction: The advent of the COVID-19 pandemic (caused by severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] has had an impact on the management of other pathologies due to the high healthcare pressure generated. Due to its natural history, bladder cancer amenable to radical cystectomy requires special attention. We aim to compare the perioperative and oncological results of these patients during the alarm state with respect to the pre-COVID era in a tertiary care center. Material and methods: Observational descriptive and analytical retrospective research. Patients who underwent radical cistectomy because of bladder cancer between April 2019 to March 2021, divided in two groups, April 2019-March 2020 (n = 42) and April 2020-March 2021 (n = 43). Results: Both groups turned out to be homogeneous. The median wait time from transurethral resection of the bladder to radical cystectomy did not increase (82.5 vs. 83 days, p = 0.860). No differences were observed in the TNM staging of the surgical specimens. Locally advanced tumors did not increase significantly (18 vs. 21, p = 0.580). The presence of lymph node involvement did not present significant differences either (10 vs. 13, p = 0.675). The average stay decreased by a value close to significance (median in days 11 vs. 8, p = 0.056) without being associated with a greater number of complications or readmissions at 30 days. Conclusion: In our series, we have not found significant differences in the perioperative and oncological results of patients treated by radical cystectomy during the COVID-19 pandem

La controversia bioética sobre el triaje durante la pandemia de la COVID-19 / La controvèrsia bioètica sobre el triatge durant la pandèmia de la COVID-19 / The bioethical controversy over triage during the COVID-19 pandemic

La pandemia de la COVID-19 ha puesto en crisis a los sistemas públicos de salud con el aumento acelerado de ingresos a los servicios de urgencias y unidades de cuidados intensivos (UCI). Esta demanda de atención crítica en situación de emergencia sanitaria mundial ha suscitado la necesidad de aplicar métodos de triaje para seleccionar a las personas que tengan más probabilidades de sobrevivir con mejor calidad de vida y años de supervivencia. Sin embargo, las difíciles decisiones sobre el triaje no son una cuestión meramente médica, sino una decisión bioética que implica tomar en cuenta otros criterios sociales para seleccionar justa y equitativamente a las personas. Estas decisiones deben ser deliberadas y avaladas por comités hospitalarios de bioética, no deben ser tomadas únicamente por el personal sanitario. Este artículo aborda el problema de manera general y se refiere a la situación en México a partir de algunos datos disponibles. Se cuestiona el uso de métodos aleatorios y de orden de llegada al hospital por no ser los más justos y eficientes en el uso de recursos escasos de medicina crítica duranteesta pandemia. Se discute también la viabilidad de emplear, junto con los criterios médicos, los criterios de “utilidad social”, algunos de los cuales ya han sido aplicados en casos de listas de espera en trasplantes de órganos, en casos de desempate y para ayudar a una selección más cuidadosa de pacientes con la finalidad de incrementar el número de personas beneficiadas en las UCI y la calidad de vida de las supervivientes.(AU)

The COVID-19 pandemic has put public health systems in crisis due to the accelerated increase in admissions to emergency services and intensive care units (ICU). This demand for critical care in a global health emergency has led to the need for triage methods to adequately select the patients most likely to survive the disease with better quality of life and years of survival. However, problematic decisions about triage are not merely amedical matter, but a bioethical decision that involves considering other social criteria to select patients fairly and equitably. These decisions must be deliberate and endorsed by hospital bioethics committees, they should not be taken solely by the health personnel in charge. This article addresses the problem in a general way and refers to the situation in Mexico, based on available data. The use of random and first-come arrival methods at the hospital is questioned for not being the fairest and most efficient in the use of scarce critical medicine resources during this pandemic. It also discusses the feasibility of using, together with medical criteria, the criteria of "social utility", some of which have already been applied in cases of waiting lists in organ transplants, in cases of tie-breaking and to help a more careful selection of patients to increase the number of people benefited in the ICU and the quality of life of the survivors.(AU)

La pandèmia de la COVID-19 ha posat en crisi als sistemes públics de salut amb l'augment accelerat d'ingressos als serveis d'urgències i unitats de vigilància intensiva (UCI). Aquesta demanda d'atenció crítica en situació d'emergència sanitària mundial ha suscitat la necessitat d'aplicar mètodes de triatge per a seleccionar a les persones que tinguin més probabilitats de sobreviure amb millor qualitat de vida i anys de supervivència. No obstant això, les difícils decisions sobre el triatge no són una qüestió merament mèdica, sinó una decisió bioètica que implica tenir en compte altres criteris socials per a seleccionar justa i equitativament a les persones. Aquestes decisions han de ser deliberades i avalades per comitès hospitalaris de bioètica, no han de ser preses únicament pel personal sanitari. Aquest article aborda el problema de manera general i es refereix a la situació a Mèxic a partir d'algunes dades disponibles. Es qüestiona l'ús de mètodes aleatoris i d'ordre d'arribada a l'hospital per no ser elsmés justos i eficients en l'ús de recursos escassos de medicina crítica durant aquesta pandèmia. Es discuteix també la viabilitat d'emprar, juntament amb els criteris mèdics, els criteris de “utilitat social”, alguns dels quals ja han estat aplicats en casos de llistes d'espera en trasplantaments d'òrgans, en casos de desempat i per a ajudar a una selecció més acurada de pacients amb la finalitat d'incrementar el nombre de persones beneficiades en les UCI i la qualitat de vida de les supervivents.(AU)

In flux: Annual transport and deposition of suspended heavy metals and trace elements in the urbanised, tropical Red River Delta, Vietnam.

Due to the depositional environment, river deltas are said to act as filters and sinks for pollutants. However, many deltas are also densely populated and rapidly urbanizing, creating new and increased sources of pollutants. These sources pose the risk of tipping these environments from pollution sinks to sources, to the world's oceans. We provide detailed seasonal and annual assessments of metal contaminants in riverine suspended particulate matter (SPM) across the densely populated Red River Delta (RRD), Vietnam. The global contributions of elements from the RRD are all <0.2% with many elemental fluxes <0.01%, suggesting the RRD is not a major source of elemental pollution to the ocean. However, 'hotspots' of metal pollution due to human activity and the impacts of tropical storm Son Tinh (July 2018) exceed both national level regulations and international measures of toxicity (e.g. enrichment factors). There is widespread 'extreme pollution' of Cd (enrichment factor >40) and concentrations of As higher than national regulation limits (>17 mg/Kg) at all sites other than one upstream, agricultural-dominated tributary in the dry season. These 'hotspots' are characterised by high inputs of organic matter (e.g. manure fertiliser and urban wastewater), which influences elemental mobility in the particulate and dissolved phases, and are potentially significant sources of pollution downstream. In addition, in the marine and fresh water mixing zone, salinity effects metal complexation with organic matter increasing metals in the particulate phase. Our calculations indicate that the delta is currently acting as a pollutant sink (as determined by high levels of pollutant deposition ∼50%). However, increased in-washing of pollutants and future projected increases in monsoon intensity, saline intrusion, and human activity could shift the delta to become a source of toxic metals. We show the importance of monitoring environmental parameters (primarily dissolved organic matter and salinity) in the RRD to assess the risk of transport and accumulation of toxic metals in the delta sediments, which can lead to net-increases in anthropogenic pollution in the coastal zone and the incorporation of toxic elements in the food chain.

Human practices behind the aquatic and terrestrial ecological decoupling to climate change in the tropical Andes.

Anthropogenic climate change and landscape alteration are two of the most important threats to the terrestrial and aquatic ecosystems of the tropical Americas, thus jeopardizing water and soil resources for millions of people in the Andean nations. Understanding how aquatic ecosystems will respond to anthropogenic stressors and accelerated warming requires shifting from short-term and static to long-term, dynamic characterizations of human-terrestrial-aquatic relationships. Here we use sediment records from Lake Llaviucu, a tropical mountain Andean lake long accessed by Indigenous and post-European societies, and hypothesize that under natural historical conditions (i.e., low human pressure) vegetation and aquatic ecosystems' responses to change are coupled through indirect climate influences-that is, past climate-driven vegetation changes dictated limnological trajectories. We used a multi-proxy paleoecological approach including drivers of terrestrial vegetation change (pollen), soil erosion (Titanium), human activity (agropastoralism indicators), and aquatic responses (diatoms) to estimate assemblage-wide rates of change and model their synchronous and asynchronous (lagged) relationships using Generalized Additive Models. Assemblage-wide rate of change results showed that between ca. 3000 and 400 calibrated years before present (cal years BP) terrestrial vegetation, agropastoralism and diatoms fluctuated along their mean regimes of rate of change without consistent periods of synchronous rapid change. In contrast, positive lagged relationships (i.e., asynchrony) between climate-driven terrestrial pollen changes and diatom responses (i.e., asynchrony) were in operation until ca. 750 cal years BP. Thereafter, positive lagged relationships between agropastoralism and diatom rates of changes dictated the lake trajectory, reflecting the primary control of human practices over the aquatic ecosystem prior European occupation. We interpret that shifts in Indigenous practices (e.g., valley terracing) curtailed nutrient inputs into the lake decoupling the links between climate-driven vegetation changes and the aquatic community. Our results demonstrate how rates of change of anthropogenic and climatic influences can guide dynamic ecological baselines for managing water ecosystem services in the Andes.

Combined Effect of Microplastics and Cd Alters the Enzymatic Activity of Soil and the Productivity of Strawberry Plants.

The synergistic effect between heavy metals and microplastics can affect soil properties as well as plant performance and yield. The objective of this study was to evaluate the combined effect of microplastics and cadmium on a soil-plant system. Specifically, we proposed to explore changes in soil microbiological activity, the growth and yield parameters of strawberry plants, and to evaluate the accumulation of these pollutants in the soil and root system. Plants were planted in clay pots under greenhouse conditions. The experiment was set up as a completely randomized design, with four treatments (Control; MPs; Cd; and Cd + MPs) and five replicates. The results showed that MPs and/or Cd affected plant growth, plant biomass, the number of fruits, root characteristics, dehydrogenase activity, acid phosphatase, and microbial biomass, and increased the accumulation of Cd in the roots and soil. The increased bioavailability of Cd, due to the presence of microplastics, could explain the observed negative effects on soil properties and the performance of strawberry plants.

Arterial malformations leading to bilateral spontaneous renal hemorrhage in a dog.

OBJECTIVE: To describe the clinical presentation, diagnostic imaging, management, and follow-up of a dog that presented with sequential, bilateral, spontaneous, subcapsular and perirenal hemorrhage (Wunderlich syndrome) due to bilateral renal arterial malformations. CASE SUMMARY: A 9-year-old intact male Field Spaniel presented for acute onset abdominal pain following a possible syncopal episode. Abdominal ultrasonography, contrast-enhanced ultrasound, and computed tomography (CT) revealed right-sided perirenal hemorrhage that extended into the peritoneum. The dog was discharged following stabilization with analgesia, fluid therapy, and tranexamic acid. One month later, the patient presented with identical clinical signs. A CT scan at this stage revealed bilateral kidney infarcts with new left-sided perirenal hemorrhage. Abdominal ultrasound and contrast-enhanced ultrasound were repeated and showed similar findings. Follow up with four-dimensional CT angiography revealed bilateral renal arterial malformations, likely causing spontaneous renal hemorrhage and secondary subcapsular hematomas , retroperitoneal and peritoneal hemorrhage. UNIQUE INFORMATION PROVIDED: This is the first reported case of both bilateral renal arterial malformations and bilateral spontaneous subcapsular and perirenal hemorrhage in the absence of neoplasia, coagulopathy, or trauma in a dog. Advanced imaging modalities, including selective angiography, were required to diagnose this condition successfully. Arterial malformations should be considered as a differential diagnosis in cases of hemoretroperitoneum. Nephrectomy due to perirenal hemorrhage should be cautiously considered, especially in the absence of angiography, because of the sequential bilateral nature of this case. Conservative management in this case resulted in a good long-term outcome 10 months later.

River connectivity and climate behind the long-term evolution of tropical American floodplain lakes.

This study presents the long-term evolution of two floodplains lakes (San Juana and Barbacoas) of the Magdalena River in Colombia with varying degree of connectivity to the River and with different responses to climate events (i.e., extreme floods and droughts). Historical limnological changes were identified through a multiproxy-based reconstruction including diatoms, sedimentation, and sediment geochemistry, while historical climatic changes were derived from the application of the Standardised Precipitation-Evapotranspiration Index. The main gradients in climatic and limnological change were assessed via multivariate analysis and generalized additive models. The reconstruction of the more isolated San Juana Lake spanned the last c. 500 years. Between c. 1,620 and 1,750 CE, riverine-flooded conditions prevailed as indicated by high detrital input, reductive conditions, and dominance of planktonic diatoms. Since the early 1800s, the riverine meander became disconnected, conveying into a marsh-like environment rich in aerophil diatoms and organic matter. The current lake was then formed around the mid-1960s with a diverse lake diatom flora including benthic and planktonic diatoms, and more oxygenated waters under a gradual increase in sedimentation and nutrients. The reconstruction for Barbacoas Lake, a waterbody directly connected to the Magdalena River, spanned the last 60 years and showed alternating riverine-wetland-lake conditions in response to varying ENSO conditions. Wet periods were dominated by planktonic and benthic diatoms, while aerophil diatom species prevailed during dry periods; during the two intense ENSO periods of 1987 and 1992, the lake almost desiccated and sedimentation rates spiked. A gradual increase in sedimentation rates post-2000 suggests that other factors rather than climate are also influencing sediment deposition in the lake. We propose that hydrological connectivity to the Magdalena River is a main factor controlling lake long-term responses to human pressures, where highly connected lakes respond more acutely to ENSO events while isolated lakes are more sensitive to local land-use changes.

Epidemiology and Clinical Characteristics of Non-Hodgkin Lymphoma in Mexico.

BACKGROUND: There is no epidemiological registry in Mexico. The information about the epidemiology in our country is obtained by these types of studies, such as multicentric studies. A lot of improvements in the survival in non-Hodgkin lymphoma patients had occurred in the last 20 years. The access to treatment in these types of pathology could change the prognostic factors in Mexican Mestizos patients. The primary objective of the study was to learn what the most frequent histological varieties of non-Hodgkin lymphoma in Mexico are. The secondary objectives included clinical characteristics, treatments used, treatment response, disease-free survival and overall survival. METHODS: A retrospective, descriptive study of consecutive cases was carried out in 14 hospitals across 14 Mexican states with patients diagnosed with non-Hodgkin lymphoma using the World Health Organization (WHO) 2008 criteria. Inclusion criteria included: ≥ 18 years of age, male or female, any clinical stage at diagnosis, who had received any chemotherapy regimen, with a known outcome. Descriptive statistics was performed for all variables, and survival was assessed using Kaplan-Meier curves. RESULTS: Totally, 609 patients were enrolled, of which 545 were B-cell lymphomas and 64 were T-cell lymphomas. Median ages were 61 and 50, respectively. B-cell lymphomas were more common in males with 52.1%, and 65.5% of T-cell lymphomas occurred in females. For B-cell lymphomas, the two most frequent histological subtypes were diffuse large B-cell lymphoma in 63.9%, followed by follicular lymphoma at 18%. Meanwhile, 50% of T-cell lymphomas were of the T/natural killer (NK) subtype, and 87.1% of the patients received a CHOP-like regimen. Radiotherapy was given to 31% of B-cell Lymphomas and 46.9% of T-cell lymphomas. Overall survival at 9 years was 84.6% for B-cell lymphomas, and 73.4% for T-cell lymphomas. CONCLUSIONS: Diffuse large B-cell lymphoma constitutes the most frequent subtype for B-cell lymphomas in Mexico. The most frequent T-cell lymphoma is the NK/T histological subtype.

Comparing the Temporal Development of Wheat Spike Blast Epidemics in a Region of Bolivia Where the Disease Is Endemic.

Epidemics of wheat blast, caused the Triticum pathotype of Magnaporthe oryzae, were studied in the Santa Cruz del la Sierra region of Bolivia to quantify and compare the temporal dynamics of the disease under different growing conditions. Six plots of a susceptible wheat cultivar were planted at Cuatro Cañadas (CC), Okinawa 1 (OK1), and Okinawa 2 (OK2) in 2015. Spike blast incidence (INC) and severity (SEV) and leaf blast severity (LEAF) were quantified in each plot at regular intervals on a 10 × 10 grid (n = 100 clusters of spikes), beginning at head emergence (Feekes growth stage 10.5), for a total of nine assessments at CC, six at OK1, and six at OK2. Spike blast increased over time for 20 to 30 days before approaching a mean INC of 100% and a mean SEV of 60 to 75%. The logistic model was the most appropriate for describing the temporal dynamics of spike blast. The highest absolute rates of disease increase occurred earliest at OK1 and latest at OK2, and in all cases it coincided with major rain events. Estimated y0 values (initial blast intensity) were significantly (P < 0.05) higher at OK1 than at CC or OK2, whereas rL values (the logistic rate parameter) were significantly higher at OK2 than at CC or OK1. It took about 10 fewer days for SEV to reach 10, 15, or 20% at OK1 compared with OK2 and CC. Based on survival analyses, the survivor functions for time to 10, 15 and 20% SEV (ts) were significantly different between OK1 and the other locations, with the probabilities of SEV reaching the thresholds being highest at OK1. LEAF at 21 days after Feekes 10.5 had a significant effect on ts at OK1. For every 5% increase in LEAF, the chance of SEV reaching the thresholds by day 21 increased by 30 to 55%.

Impacto en la mortalidad tras la implantación de una red de atención al infarto agudo de miocardio con elevación del segmento ST. Estudio IPHENAMIC / Impact on mortality after implementation of a network for ST-segment elevation myocardial infarction care. The IPHENAMIC study

INTRODUCCIÓN Y OBJETIVOS: Se sabe muy poco del impacto que las redes de atención del infarto agudo de miocardio con elevación del segmento ST (IAMCEST) tienen en la población. El objetivo de este estudio es averiguar si el PROGALIAM (Programa Gallego de Atención al Infarto Agudo de Miocardio) mejoró la supervivencia en la zona norte de Galicia. MÉTODOS: Se recogieron todos los eventos codificados como IAMCEST entre 2001 y 2013. Se identificó a 6.783 pacientes, divididos en 2 grupos: pre-PROGALIAM (2001-2005), 2.878 pacientes, y PROGALIAM (2006-2013), 3.905 pacientes. RESULTADOS: En la etapa pre-PROGALIAM, la mortalidad ajustada a 5 años fue superior tanto en la población total (HR=1,22; IC95%, 1,14-1,29; p < 0,001), como en cada una de las áreas (A Coruña, HR=1,12; IC95%, 1,02-1,23; p = 0,02; Lugo, HR=1,34; IC95%, 1,2-1,49; p <0,001, y Ferrol, HR=1,23; IC95%, 1,1-1,4; p = 0,001). Antes del PROGALIAM, la mortalidad a 5 años en las áreas de Lugo (HR=0,8; IC95%, 0,67-0,95; p = 0,02) y Ferrol (HR=0,75; IC95%, 0,64-0,88; p = 0,001) era superior que en A Coruña. Estas diferencias desaparecieron tras el desarrollo de la red (Lugo comparado con A Coruña, HR=0,88; IC95%, 0,72-1,06; p = 0,18; Ferrol comparado con A Coruña, HR=1,04; IC95%, 0,89-1,22; p = 0,58. CONCLUSIONES: El desarrollo del PROGALIAM en el área norte de Galicia disminuyó la mortalidad e incrementó la equidad de los pacientes con IAMCEST tanto en general como en cada una de las áreas donde se implantó

INTRODUCTION AND OBJECTIVES: Little is known about the impact of networks for ST-segment elevation myocardial infarction (STEMI) care on the population. The objective of this study was to determine whether the PROGALIAM (Programa Gallego de Atención al Infarto Agudo de Miocardio) improved survival in northern Galicia. METHODS: We collected all events coded as STEMI between 2001 and 2013. A total of 6783 patients were identified and divided into 2 groups: pre-PROGALIAM (2001-2005), with 2878 patients, and PROGALIAM (2006-2013), with 3905 patients. RESULTS: In the pre-PROGALIAM period, 5-year adjusted mortality was higher both in the total population (HR, 1.22, 95%CI, 1.14-1.29; P <.001) and in each area (A Coruña: HR, 1.12; 95%CI, 1.02-1.23; P=.02; Lugo: HR, 1.34; 95%CI, 1.2- 1.49; P <.001 and Ferrol: HR, 1.23; 95%CI, 1.1-1.4; P=.001). Before PROGALIAM, 5-year adjusted mortality was higher in the areas of Lugo (HR, 1.25; 95%CI, 1.05-1.49; P=.02) and Ferrol (HR, 1.32; 95%CI, 1.13-1.55; P=.001) than in A Coruña. These differences disappeared after the creation of the STEMI network (Lugo vs A Coruña: HR, 0.88; 95%CI, 0.72-1.06; P=.18, Ferrol vs A Coruña: HR, 1.04; 95%CI, 0.89-1.22; P=.58. CONCLUSIONS: For patients with STEMI, the creation of PROGALIAM in northern Galicia decreased mortality and increased equity in terms of survival both overall and in each of the areas where it was implemented

A century of limnological evolution and interactive threats in the Panama Canal: Long-term assessments from a shallow basin.

Large tropical river dam projects are expected to accelerate over the forthcoming decades to satisfy growing demand for energy, irrigation and flood control. When tropical rivers are dammed the immediate impacts are relatively well studied, but the long-term (decades-centuries) consequences of impoundment remain poorly known. We combined historical records of water quality, river flow and climate with a multi-proxy (macrofossils, diatoms, biomarkers and trace elements) palaeoecological approach to reconstruct the limnological evolution of a shallow basin in Gatun Lake (Panama Canal, Panama) and assess the effects of multiple linked factors (river damming, forest flooding, deforestation, invasive species, pollution and hydro-climate) on the study area. Results show that a century after dam construction, species invasion, deforestation and salt intrusions have forced a gradual change in the study basin from a swamp-type environment towards a more saline lake-governed system of benthic-littoral production likely associated with the expansion of macrophyte stands. Hydrology still remains the most important long-term (decades) structural factor stimulating salinity intrusions, primary productivity, deposition of minerals, and reduction of water transparency during wet periods. During dry periods, physical-chemical conditions are in turn linked to clear water and aerobic conditions while nutrients shift to available forms for the aquatic biota in the detrital-rich reductive sediments. Our study suggests that to preserve the natural riverine system functioning of this area of the Panama Canal, management activities must address long-term ecosystem structural drivers such as river flow, runoff patterns and physical-chemical conditions.

Considerations on genetic engineering: regarding the birth of twins subjected to gene edition.

In this essay, the bioethical implications of the recent genetic manipulation in human embryos with CRISPR-Cas9 to eliminate the CCR5 gene and the birth of a pair of discordant twin girls are analyzed. The experiment was disseminated via social media. The main bioethical flaws identified include the justification of the model, the informed consent process and the lack of disclosure of evident conflicts of interest. The consequences of the experiment on the life of the twins that were born were not properly evaluated, such as the impact on their autonomy, the alleged benefits to be received and the future risks of harm during their lifetime. Having manipulated the germ cell line, the effects on their future offspring were not considered. This type of actions negatively affects the way society conceives science. Genetic engineering should be reserved to the basic experimental context or as clinical research for the correction of known serious diseases of genetic origin under strict regulatory and bioethical supervision and using a gradualist approach in accordance with the advances of gene editing techniques.

En este ensayo se analizan las implicaciones bioéticas de la reciente manipulación genética en embriones humanos con CRISPR-Cas9 para eliminar el gen CCR5 y el nacimiento de dos gemelas discordantes. El experimento se divulgó en medios sociales. Los principales problemas bioéticos identificados son la justificación del modelo, el proceso de consentimiento informado y la falta de declaración de evidentes conflictos de interés. No se evaluaron apropiadamente las consecuencias del experimento sobre la vida de las gemelas nacidas como la afectación a su autonomía, los supuestos beneficios por recibir y los riesgos futuros de daño durante su vida. Habiendo manipulado la línea celular germinal, no se consideraron los efectos sobre su descendencia futura. Este tipo de acciones tiene un impacto negativo en la forma como la sociedad concibe la ciencia. La ingeniería genética debe reservarse al contexto experimental básico o bien como investigación cínica para la corrección de enfermedades conocidas graves de origen genético, bajo estricta supervisión regulatoria y bioética y de manera gradualista de acuerdo con el progreso de las técnicas de edición genética.

Impact on mortality after implementation of a network for ST-segment elevation myocardial infarction care. The IPHENAMIC study.

INTRODUCTION AND OBJECTIVES: Little is known about the impact of networks for ST-segment elevation myocardial infarction (STEMI) care on the population. The objective of this study was to determine whether the PROGALIAM (Programa Gallego de Atención al Infarto Agudo de Miocardio) improved survival in northern Galicia. METHODS: We collected all events coded as STEMI between 2001 and 2013. A total of 6783 patients were identified and divided into 2 groups: pre-PROGALIAM (2001-2005), with 2878 patients, and PROGALIAM (2006-2013), with 3905 patients. RESULTS: In the pre-PROGALIAM period, 5-year adjusted mortality was higher both in the total population (HR, 1.22, 95%CI, 1.14-1.29; P <.001) and in each area (A Coruña: HR, 1.12; 95%CI, 1.02-1.23; P=.02; Lugo: HR, 1.34; 95%CI, 1.2-1.49; P <.001 and Ferrol: HR, 1.23; 95%CI, 1.1-1.4; P=.001). Before PROGALIAM, 5-year adjusted mortality was higher in the areas of Lugo (HR, 1.25; 95%CI, 1.05-1.49; P=.02) and Ferrol (HR, 1.32; 95%CI, 1.13-1.55; P=.001) than in A Coruña. These differences disappeared after the creation of the STEMI network (Lugo vs A Coruña: HR, 0.88; 95%CI, 0.72-1.06; P=.18, Ferrol vs A Coruña: HR, 1.04; 95%CI, 0.89-1.22; P=.58. CONCLUSIONS: For patients with STEMI, the creation of PROGALIAM in northern Galicia decreased mortality and increased equity in terms of survival both overall and in each of the areas where it was implemented. This study was registered at ClinicalTrials.gov (Identifier: NCT02501070).

Reflexiones sobre la ingeniería genética: a propósito del nacimiento de gemelas sometidas a edición génica / Considerations on genetic engineering: regarding the birth of twins subjected to gene edition

Resumen En este ensayo se analizan las implicaciones bioéticas de la reciente manipulación genética en embriones humanos con CRISPR-Cas9 para eliminar el gen CCR5 y el nacimiento de dos gemelas discordantes. El experimento se divulgó en medios sociales. Los principales problemas bioéticos identificados son la justificación del modelo, el proceso de consentimiento informado y la falta de declaración de evidentes conflictos de interés. No se evaluaron apropiadamente las consecuencias del experimento sobre la vida de las gemelas nacidas como la afectación a su autonomía, los supuestos beneficios por recibir y los riesgos futuros de daño durante su vida. Habiendo manipulado la línea celular germinal, no se consideraron los efectos sobre su descendencia futura. Este tipo de acciones tiene un impacto negativo en la forma como la sociedad concibe la ciencia. La ingeniería genética debe reservarse al contexto experimental básico o bien como investigación cínica para la corrección de enfermedades conocidas graves de origen genético, bajo estricta supervisión regulatoria y bioética y de manera gradualista de acuerdo con el progreso de las técnicas de edición genética.

Abstract In this essay, the bioethical implications of the recent genetic manipulation in human embryos with CRISPR-Cas9 to eliminate the CCR5 gene and the birth of a pair of discordant twin girls are analyzed. The experiment was disseminated via social media. The main bioethical flaws identified include the justification of the model, the informed consent process and the lack of disclosure of evident conflicts of interest. The consequences of the experiment on the life of the twins that were born were not properly evaluated, such as the impact on their autonomy, the alleged benefits to be received and the future risks of harm during their lifetime. Having manipulated the germ cell line, the effects on their future offspring were not considered. This type of actions negatively affects the way society conceives science. Genetic engineering should be reserved to the basic experimental context or as clinical research for the correction of known serious diseases of genetic origin under strict regulatory and bioethical supervision and using a gradualist approach in accordance with the advances of gene editing techniques.

Standard operating procedure reduces interoperator variation and improves accuracy when measuring packed cell volume.

OBJECTIVE: To evaluate whether a standard operating procedure (SOP) for canine packed cell volume (PCV) measurement reduces operator-dependent variation and improves accuracy within a veterinary teaching hospital environment. MATERIALS AND METHODS: Clinical staff and final-year undergraduate veterinary students were recruited to perform PCV measurements in blinded duplicate samples. Participants were randomly allocated to perform this with or without an SOP. Participants' results were compared against a reference, generated by the authors following the World Health Organization guidelines. RESULTS: The study population comprised 18 clinical staff and 39 students. Three clinical staff and seven students displayed errors consistent with inaccurate reading, only one of whom had access to the SOP. Five students and two clinical staff had errors attributable to incorrect preparation, with only one having access to the SOP. Interoperator variation was significantly less using the SOP. Using the SOP, 95 per cent of the results were within 0.0125 l/l of the reference value, in comparison with within 0.09 l/l without SOP. Interoperator variation was significantly less in the SOP group (P=0.0025). CLINICAL SIGNIFICANCE: Using the SOP resulted in less variation and more accurate results. This confirms that PCV measurement with an SOP can truly be a 'waived' test.

Bioabsorption and Bioaccumulation of Cadmium in the Straw and Grain of Maize (Zea mays L.) in Growing Soils Contaminated with Cadmium in Different Environment.

There is a worldwide increase of heavy metal or potentially toxic element (PTE), contamination in agricultural soils caused mainly by human and industrial action, which leads to food contamination in crops such as in maize. Cadmium (Cd) is a PTE often found in soils and it is ingested through food. It is necessary to determine the bioabsorption, distribution, and accumulation levels in maize to reduce or prevent food chain contamination. Cadmium absorption and accumulation in three maize cultivars were evaluated in three agricultural environments in Chile by increasing CdCl2 rates (0, 1, and 2 mg·kg-1). Evaluation included Cd accumulation and distribution in different plant tissues, bioaccumulation factor (BAF), bioconcentration factor (BCF), translocation factor (TF), and tolerance index (TI). Cadmium whole-plant uptake was only affected by the CdCl2 rate; the highest uptake was obtained with 2 mg·kg-1 CdCl2 (34.4 g·ha-1) (p < 0.05). Cadmium distribution in the maize plant usually exhibited the highest accumulation in the straw (p < 0.05), independently of the environment, Cd rate, and evaluated cultivar. Given the results for TF (TF > 2) and BAF (BAF > 1), the Los Tilos and Chillán environments were classified as having a high capacity to contaminate the food chain for all evaluated cultivars.

Características clínicas y epidemiológicas de leishmaniasis en el municipio de Trojes, El Paraíso, 2014-2017 / Clinical and epidemiological characteristics of Leishmaniasis in the municipality of Trojes, El Paraíso, 2014-2017

Antecedentes. Las enfermedades parasitarias tienen una distribución universal y son causa de una significativa mor - bimortalidad, principalmente en las regiones tropicales del mundo, asociadas a un bajo grado de desarrollo, malas condiciones higiénico-sanitarias, y determinadas condiciones ecológicas. Objetivo. describir las características clínicas y epidemiológicas de Leishmaniasis en el municipio Trojes, departamento de El Paraíso, Honduras en el período 2014-2017. Metodología. Estudio descrip - tivo transversal, 45,393 pacientes atendidos, 388 presentaron Leishmaniasis (0.8%). tamaño de muestra estimado de 204 (52.6%, IC95%). Variables incluidas: características sociodemográficas, epidemiológicas, datos clínicos, laboratoriales, diagnóstico y trata - miento. Se ingreso informacion en base de datos Epiinfo versión 7.1.5 (CDC, Atlanta). Los resultados se presentan como frecuencias, porcentajes, rangos y promedios. La información personal de los casos se manejó confidencialmente. Resultados. El tipo de Leish - maniasis más frecuente fue la forma cutánea en un 89.1% (188), el grupo etáreo más afectado fue el adulto joven (20-39 años) 37.8% (77), siendo estos de género masculino 61.8% (126). La zona anatómica más afectada fueron las extremidades superiores 43.6%(89), el tamaño de la lesión fue entre 2-10 cm 64.2%(131). El 96.1%(196) permaneció en zonas boscosas.74.5% (152) no presentaron síntomas. En el 100%(204) de los pacientes se utilizó Antimoniato de Meglumina (Glucantime) Discusión. Las herramientas para la prevención y el control de esta parasitosis son limitadas, por lo que es importante para las personas expuestas participar en acciones con el fin de reducir el contacto entre seres humanos y vectores. El diagnóstico precoz y oportuno, así como el tratamiento adecuado son cruciales para mejorar la calidad de vida del paciente...(AU)

Effects of Row Spacing and Nitrogen Rate on Wheat Grain Yield and Profitability as Influenced by Diseases.

In Ohio, changes in nitrogen (N) fertilizer application rates and row spacing in combination with fungicide applications have been proposed as possible strategies for increasing wheat productivity and profitability. Field experiments were conducted in 2013, 2014, and 2015 to evaluate the benefits of increasing row spacing and N rates in soft red winter wheat as influenced by diseases. Combinations of narrow (19 cm) and wide (38 cm) row spacings, N rates ranging from 34 to 180 kg ha-1, and the fungicide prothioconazole + tebuconazole applied at flag leaf emergence, boot, or early anthesis represented different management programs. Linear mixed model analyses were performed to evaluate the effects of N, row spacing, and fungicide timing on leaf rust, Fusarium head blight (FHB), and deoxynivalenol (DON), and to quantify relationships among leaf rust, N, grain yield (YLD), and test weight (TW). YLD, TW, grain prices and price discounts, as well as input costs were used to estimate net cash income (NCI) for each management program. Wide row wheat had statistically higher mean FHB and DON, and lower mean yield and test weight than narrow row wheat in 2014 and 2015 but not in 2013. There were significant positive linear relationships between leaf rust and N as well as YLD and TW with N. Differences in FHB and DON among N rates were not statistically significant. Leaf rust severity was consistently lower in treated plots, with efficacy influenced by N rate and application timing. Programs with narrow row spacing and treated with the fungicide generally resulted in the highest mean YLD and TW across N rates. Price discounts due to high FDK and DON, and low TW were higher, and consequently, NCIs were lower in 2014 and 2015 than in 2013. The highest NCIs were obtained for programs with the highest YLD and lowest price discounts, consequently programs with wide row spacing, a fungicide treatment, and high N rates were only economically beneficial when FHB levels were low and grain prices were high.

Quantifying the effects of fusarium head blight on grain yield and test weight in soft red winter wheat.

Fusarium head blight (FHB), caused by the fungus Fusarium graminearum, is known to negatively affect wheat grain yield (YLD) and test weight (TW). However, very little emphasis has been placed on formally quantifying FHB-YLD and FHB-TW relationships. Field plots of three soft red winter wheat cultivars-'Cooper' (susceptible to FHB), 'Hopewell' (susceptible), and 'Truman' (moderately resistant)-were grown during the 2009, 2010, 2011, and 2012 seasons, and spray inoculated with spore suspensions of F. graminearum and Parastagonospora nodorum to generate a range of FHB and Stagonospora leaf blotch (SLB) levels. FHB index (IND) and SLB were quantified as percent diseased spike and flag leaf area, respectively, and YLD (kg ha(-1)) and TW (kg m(-3)) data were collected. Using IND as a continuous covariate and cultivar (CV) and SLB as categorical fixed effects, linear mixed-model regression analyses (LMMR) were used to model the IND-YLD and IND-TW relationship and to determine whether these relationships were influenced by CV and SLB. The final models fitted to the data were of the generic form y=a+b (IND), where a (intercept) or b (slope) could also depend on other factors. LMMR analyses were also used to estimate a and b by combining the studies from these 4 years with an additional 16 experiments conducted from 2003 to 2013, and bivariate random-effects meta-analysis was used to estimate population mean b ([Formula: see text]) and a (a) for the IND-YLD relationship. YLD and TW decreased as IND increased, with b ranging from -3.2 to -2.3 kg m(-3) %(-1) for TW. For the IND-YLD relationship, [Formula: see text] was -51.7 kg ha(-1) %IND(-1) and a was 4,426.7 kg ha(-1). Neither cultivar nor SLB affected the IND-YLD relationship but SLB affected a of the IND-TW regression lines, whereas cultivar affected b. Plots with the highest levels of SLB (based on ordinal categories for SLB) had the lowest a and Hopewell had the highest b. The level of IND at which a 50-kg m(-3) reduction in TW was predicted to occur was 19, 16, and 22% for Cooper, Hopewell, and Truman, respectively. A yield loss of 1 MT ha(-1) was predicted to occur at 19% IND. The rate of reduction in relative TW or YLD per unit increase in IND was between -0.39 and -0.32%(-1) for TW and -1.17%(-1) for YLD. Results from this study could be integrated into more general models to evaluate the economics of FHB management strategies.