[Ten-year survival after off-pump coronary artery bypass grafting compared with traditional bypass grafting]. / Cirugía de revascularización miocárdica: comparación de supervivencia a 10 años de la cirugía coronaria con y sin circulación extracorpórea mediante Propensity Score Matching.

BACKGROUND: Long-term outcomes of Off-Pump Coronary Artery Bypass Grafting (OPCAB) as an alternative to the traditional Coronary Artery Bypass Grafting (CABG) technique with cardiopulmonary bypass (CPB) are not well defined. AIM: To compare 10-year survival of isolated OPCAB versus CABG with CPB. MATERIAL AND METHODS: Analysis of information obtained from databases, clinical records and surgical protocols of patients treated with isolated CABG between January 2006 and November 2008 at a Regional Hospital. Of 658 isolated CABG, 192 (29.2%) were OPCAB and 466 (79.9%) CPB. Propensity Score Matching (PSM) was performed to compare both groups. After PSM, two groups of 192 cases were obtained. Mortality data was obtained from the Chilean public identification service. Ten-year survival was calculated and compared with Kaplan-Meier and log-rank methods. RESULTS: Follow-up data was obtained in all cases. No statistically significant differences were found when comparing 10-year survival between OPCAB versus CPB (78.6% and 80.2% respectively, p 0.720). There was also no statistical difference in cardiovascular death free survival (90.1% with CPB versus 89.1% OPCAB, p 0.737). Survival was comparable when analyzing subgroups with diabetes mellitus, left ventricular dysfunction or chronic kidney disease, among others. CONCLUSIONS: In our series, OPBAB has a comparable 10-year survival with CABG with CPB.

[Coronary artery bypass grafting: evolution of coronary disease characteristics and immediate surgical outcomes over a decade]. / Cirugía coronaria: evolución de las características de la enfermedad coronaria y resultados inmediatos de la cirugía de revascularización miocárdica en una década.

INTRODUCTION: Several factors intervene in the evolution of the characteristics of Coronary artery bypass grafting (CABG), such as demographic changes, surgical technique, and perioperative care. Our objective was to analyze the evolution of the characteristics of coronary artery disease in patients treated with CABG and its immediate results. METHODS: In an analytical study, we analyzed a cohort of patients with isolated CABG from January 2006 to December 2008 and from January 2016 to December 2018 in Hospital Clínico Regional Concepción, Chile. After the ethics committee's approval, we reviewed the database and surgical protocols. We used Chi-square and U Mann Whitney tests for statistical analysis (SPSSv25®), considering significant p < 0,05. RESULTS: We analyzed 1,400 isolated CABG, 658 from the first period and 742 from the second, with a mean age of 62.0 ± 8.7 and 64.6 ± 9.3 respectively (p < 0.001). The subgroup with ventricular dysfunction in the second period showed a significant increase in diabetes mellitus, chronic obstructive pulmonary disease, acute myocardial infarction (AMI), and severe ventricular dysfunction. The second group decreased off-pump surgery and increased the use of ≥ 2 arterial grafts (p < 0.05). The Additive EuroSCORE I increased from 3.6 ± 2.5 to 4.4 ± 2.7 (p = 0.001). High-risk subgroup: 137 (20.8%) to 236 (31.8%), p < 0.001. Mortality of 13 (1.98%) and 16 (2.2%) in the first and second group respectively, p = 0.813. CONCLUSION: There was a significant increase in the estimated surgical risk; however, mortality remained unchanged. The increase in surgical risk is consistent with the increase in mean age and prevalence of comorbidities, as well as the increase in severe ventricular dysfunction in the group ofpatients with ventricular dysfunction and recent AMI in the second period.

[Lung cancer at a Chilean public hospital]. / Cáncer pulmonar: caracterización, estadificación y supervivencia en una cohorte de una década en un hospital del sistema público de salud de Chile.

BACKGROUND: Lung cancer is the world's leading cause of cancer death. AIM: To describe the clinical, staging and survival characteristics of lung cancer in a public Chilean regional hospital. MATERIAL AND METHODS: Analysis of a prospective database of a thoracic surgery service, retrieving histologically confirmed lung cancer cases from January 2010 to December 2019 and reviewing their medical records. Cases were re-staged by the TNM-8 system and variables were compared between periods 2010-2014 and 2015-2019. RESULTS: We retrieved 551 lung cancer cases, 333 (60 %) men, with a mean age of 65 years. Distant metastases were found in 72% of cases (excluding lymphatic metastases). Of the non-small cell lung cancers (NSCLC), 50 (10%) cases were in stage I, 18 (4%) in stage II, 81 (16%) in stage III and 347 (70%) in stage IV. Global five-year survival was 18%, 20% for NSCLC, 71% for excised NSCLC, 8% for non-excised NSCLC, 88% for stage I and 92% for subgroup IA. Resective surgery was performed in 81 (14%) cases. When comparing 2010-2014 and 2015-2019 periods, the frequency of resective surgery increased from 7% to 20%. CONCLUSIONS: The diagnosis of lung cancer was frequently made in advanced stages. There was a significant increase in early diagnosis and frequency of surgeries with curative intent in the second observation period.

[Suturing basic procedural skills training for medical students during COVID-19 pandemic]. / Entrenamiento procedimental básico (EPROBA) en suturas para estudiantes de medicina durante pandemia por SARS-CoV-2 (COVID-19).

BACKGROUND: The adoption of sanitary measures due to the SARS-CoV-2 pandemic hampered teaching and learning methods in medicine. AIM: To communicate the results of a wound suture training workshop, based on the Basic Procedural Skills Training methodology and adapted to the pandemic context. MATERIAL AND METHODS: One hundred fourteen students were randomized in small groups due to sanitary measures and trained with a modification of the Basic Procedural Skills Training methodology. An informed consent was obtained from every student. The suturing skills were evaluated before and after the intervention with "The Objective Structured Assessment Of Technical Skills" (OSATS) instrument. The perception of the workshop and the implementation of the COVID-19 prevention measures were also evaluated. RESULTS: The students showed a statistically significant improvement after the intervention. In the OSATS verification list, the average score increased from 4.5 to 8.6 (p < 0.01). In the OSATS global scale, the average score increased from 13.0 to 25.3 (p < 0.01). The perception of the workshop and the prevention measures were well evaluated. CONCLUSIONS: Despite all the limitations of the pandemic context, we achieved a significant improvement after the intervention and a very good perception by the students.

[Risk factors associated with 10-year survival after coronary artery bypass grafting]. / Enfermedad coronaria: factores de riesgo y supervivencia a 10 años en la cirugía coronaria.

BACKGROUND: Coronary artery bypass grafting (CABG) is the treatment of choice for a broad spectrum of patients with coronary disease. AIM: To describe global survival and factors associated with lower long-term survival in patients operated with isolated CABG. MATERIAL AND METHODS: Analysis of a cohort of patients who underwent CABG between January 2006 and December 2008 at a public hospital. The database and operation records of 1.003 cardiac surgeries were reviewed. Of these, an isolated CABG was performed in 658 patients aged 62 ± 9 years including 516 male (78%). Survival data were obtained from the Chilean Civil Registry Office and a complete ten-year follow up was accomplished. Survival was analyzed with Kaplan-Meier method with log-rank test and Cox regression. RESULTS: Operative mortality occurred in 13 patients (2%). Survival at 1, 3, 5 and 10 years was 97, 94, 91 and 76%, respectively. One, 3, 5 and 10-year free of cardiovascular death survival was 98, 97, 95 y 89%, respectively. Factors associated with long-term survival were chronic kidney disease in hemodialysis (Hazard ratio (HR) 7.9; 95% confidence intervals (CI) 4.6-13.6), chronic obstructive pulmonary disease (HR 2.3; 95% CI 1.4-3.7), chronic arterial occlusive disease (HR 2.2; 95% CI 1.4-3.4) and diabetes mellitus (HR 1.9; 95% CI 1.4-2.6). According to EuroSCORE, 10-year survival was 86, 75 and 62% (p < 0.01) in low, medium and high-risk patients, respectively. CONCLUSIONS: These patients had a 10-year survival comparable to large international series. Groups associated with lower 10-year survival were identified.

Salivary gland cancer in Southern Brazil: a prognostic study of 107 cases.

BACKGROUND: Salivary gland cancers (SGC) represent an uncommon group of heterogeneous tumors. We performed a retrospective survey of SGC diagnosed in a reference center for treatment of malignant tumors from the south of Brazil aiming to determine the prognostic value of demographic, clinic and pathologic features. MATERIAL AND METHODS: Cases diagnosed as SGC between 2006 and 2016 were retrospectively collected. Medical records were examined to extract demographic, clinic, pathologic and follow-up information. RESULTS: One-hundred and seven cases of SGC were identified. The most common SGC were mucoepidermoid carcinoma (MEC) (n = 39) followed by adenoid cystic carcinoma (AdCC) (n = 29). Among AdCCs, 55.2% of cases were classified as cribriform, 27.6% as tubular and 17.2% as solid. The tubular subtype had the highest percentage of cases with perineural invasion (p=0.01). Among MEC, 61.5% of cases were classified as low grade, 15.4% as intermediate grade and 19.9% as high grade. Low grade MEC had the lowest percentage of cases with perineural invasion (p=0.04). The 5-year survival for loco-regional control, disease-free survival (DFS) and disease-specific survival were 75%, 70% and 84%, respectively. The following features were associated with poor DFS: advanced age (p=0.03), rural residency (p=0.01), being a smoker or former smoker (p=0.01), pain (p=0.03), nodal metastasis (p<0.001), need for chemotherapy (p=0.02), neck dissection (p=0.04), perineural invasion (p=0.01), and being diagnosed with AdCC compared to MEC (p=0.02). CONCLUSIONS: The clinco-demographic and pathologic features identified as prognostic factors reveal the profile of patients at increased risk of recurrence and who would benefit from closer follow-up.

[Retention of procedural competences in medicine students after training using a simulation model]. / Retención de competencias procedimentales en estudiantes de medicina posterior a un entrenamiento mediante un modelo de simulación (EPROBA).

BACKGROUND: Boot camps are used to acquire skills in simple surgical procedures, such as sutures, in a short period of time. AIM: To assess the retention of the procedural skills of medical students who participated in a simulation-based suture workshop. MATERIAL AND METHODS: One hundred five medical students were trained using the EPROBA methodology (Entrenamiento PROcedimental BAsico), with prior informed consent. The instrument "Objective Structured Assessment Of Technical Skills" (OSATS) was applied prior to and after the workshop, and during retention module, which was carried out between three and four months after the suture workshop. Participants were classified according to the level of previous knowledge in sutures. RESULTS: The students showed significant improvement in their scores after the workshop (improvement from 12.9 to 28.5 points, p < 0.001). No significant differences were found between scores after the workshop and those obtained in the retention module (28.5 to 28.1 points, respectively, p = 0.235). No difference in scores were observed when retention was evaluated according to previous knowledge levels. CONCLUSIONS: Simulation programs are useful for the acquisition of procedural skills which are retained over time.

[Features of pulmonary hydatidosis in 368 patients admitted to a regional hospital]. / Hidatidosis pulmonar: características, manifestaciones clínicas y tratamiento en pacientes hospitalizados en Concepción, Región del Biobío, Chile.

BACKGROUND: Lungs are the second location in frequency of hydatidosis or cystic echinococcosis. AIM: To characterize the clinical manifestations, diagnosis, findings and treatment of patients hospitalized for a pulmonary hydatid cyst (PHC). MATERIALS AND METHODS: Review of databases, medical records, operation notes and death certificates of patients admitted to a Chilean regional hospital with a PHC. RESULTS: Four hundred twenty-nine cases were identified and complete data was obtained from 368 patients aged 34 ± 19 years, 224 (60,9%)men. The most common clinical manifestations were cough in 269 (73%) and chest pain in 217 (59%). The most frequent locations were the right lung in 210 (57%) and lower lobes in 218 (59%). One hundred eighty-seven cysts (51%) were complicated. Conservative surgery (cystectomy) was performed in 308 (84%). Postoperative morbidity was observed in 77 (21%) and mortality in 6 (2%) patients. Recurrence was observed in 28 (8%) patients. There was a significant reduction in morbidity, mortality, reoperations, and postoperative days over time. CONCLUSIONS: In these patients, pulmonary hydatidosis was diagnosed mainly during working ages and half of patients had a complicated cyst.

[Primary cardiac tumors. Experience in 72 cases]. / Tumores cardíacos primarios.

BACKGROUND: Primary cardiac tumors have a low incidence, and their presentation form and clinical course are not well known. AIM: To describe the characteristics, treatment, follow up and survival of patients with primary cardiac tumors (PCT). MATERIAL AND METHODS: Review of all surgical procedures for PCT performed between 1984 and 2019 in a regional general hospital. The information was obtained from surgical protocols, surgical and pathology databases, medical records and registries of the Chilean National Identification Service. The clinical features of patients, immediate and long term outcomes are described. RESULTS: Seventy-two surgical procedures for PCT were reviewed. Patients' age was 55 ± 15 years and 60% were women. The most common histological types were myxoma in 49 patients (68%), papillary fibroelastoma in 13 (18%) and sarcoma in 6 (8.3%). Forty-nine (68.1%) were symptomatic and all tumors were found on echocardiography. Fifty-one (71%) were in the left atrium, 10 (14%) in the aortic valve and eight (11%) in the right atrium. The surgical procedures were tumor resection in 48 patients (67%) and resection and repair with patch in 23 (32%). Mean postoperative stay was 6.6 ± 4.4 days, eight patients (11%) had complications and no patient died in the immediate postoperative period. Long term survival was higher in patients with benign PCT as compared with those with malignant tumors. CONCLUSIONS: Most PCTs in this group of patients were benign neoplasms and the most common tumors were myxomas. The main diagnostic method is echocardiography and the prognosis of surgical treatment is excellent when the tumors are benign. (Rev Med Chile 2020; 148: 327-335).

Effects of Osmotic Therapy on Pupil Reactivity: Quantification Using Pupillometry in Critically Ill Neurologic Patients.

BACKGROUND: Osmotic therapy is a critical component of medical management for cerebral edema. While up to 90% of neurointensivists report using these treatments, few quantitative clinical measurements guide optimal timing, dose, or administration frequency. Its use is frequently triggered by a qualitative assessment of neurologic deterioration and/or pupil size, and anecdotally appears to improve pupil asymmetry suggestive of uncal herniation. However, subjective pupil assessment has poor reliability, making it difficult to detect or track subtle changes. We hypothesized that osmotic therapy reproducibly improves quantitative pupil metrics. METHODS: We included patients at two centers who had recorded quantitative pupil measurements within 2 h before and after either 20% mannitol or 23.4% hypertonic saline in the neurosciences intensive care unit. The primary outcome was the Neurologic Pupil Index (NPi), a composite metric ranging from 0 to 5 in which > 3 is considered normal. Secondary outcomes included pupil size, percent change, constriction and dilation velocity, and latency. Results were analyzed with Wilcoxon signed-rank tests, Chi-square and multi-level linear regression to control for other edema-reducing interventions. RESULTS: Out of 72 admissions (403 paired pupil observations), NPi significantly differed within 2 h of osmotic therapy when controlling for other commonly used interventions in our whole cohort (ß = 0.08, p = 0.0168). The effect was most pronounced (ß = 0.57) in patients with abnormal NPi prior to intervention (p = 0.0235). CONCLUSIONS: Pupil reactivity significantly improves after osmotic therapy in a heterogenous critically ill population when controlling for various other interventions. Future work is necessary to determine dose-dependent effects and clinical utility.

The Marine Fungi Rhodotorula sp. (Strain CNYC4007) as a Potential Feed Source for Fish Larvae Nutrition.

Fish oil is used in the production of feed for cultured fish owing to its high polyunsaturated fatty acid content (PUFA). The over-exploitation of fisheries and events like "El Niño" are reducing the fish oil supply. Some marine microorganisms are considered potentially as alternative fatty acid sources. This study assesses a strain of Rhodotorula sp. (strain CNYC4007; 27% docosahexaenoic acid (DHA) of total fatty acids), as feed for fish larvae. The total length and ribonucleic acid (RNA)/deoxyribonucleic acid (DNA) ratio of Danio rerio larvae was determined at first feeding at six and 12 days old (post-yolk absorption larvae). Larvae fed with microencapsulated Rhodotorula sp. CNYC4007 had a significantly higher RNA/DNA ratio than control group (C1). At six days post-yolk absorption group, the RNA/DNA ratio of larvae fed with Rhodotorula sp. bioencapsulated in Brachionus sp. was significantly higher than control group fed with a commercial diet high in DHA (C2-DHA). Finally, at 12 days post-yolk absorption, the RNA/DNA ratio was significantly higher in larvae fed with Rhodotorula sp. CNYC4007 and C2-DHA (both bioencapsulated in Artemia sp. nauplii) than in control group (C1). These results suggest that Rhodotorula sp. CNYC4007 can be an alternative source of DHA for feeding fish at larval stage, providing a sustainable source of fatty acids.

Metals content in otoliths of Dicentrarchus labrax from two fish farms of Sicily.

Otoliths of cultured sea bass (Dicentrarchus labrax) from two different fish farms of Sicily were collected and analyzed by using inductively coupled plasma optical emission spectroscopy. Metal content (Ba, Cd, Fe, Mg, Mn, Sr, and Zn) was measured in order to test the potential use of biogenic carbonates as proxies of dissimilar environmental conditions since the fish farms are implanted in opposite coastal marine areas (Gulf of Castellammare and Gulf of Gela) characterized by different oceanographic features and human activities. Cluster analysis discriminates samples as different groups on the basis of metal content. Results show that concentrations of Sr in the otoliths have a similar range of distribution and not significantly different between the two farms. Otherwise, Fe, Mg, Mn, and Cd show higher concentrations in otoliths collected from fish reared in the farm in the southern coast (Gulf of Gela), an area subject to a great anthropogenic pressure. Zn is the only element with higher values in the otoliths from the farm in the northern coast (Gulf of Trappeto) probably due to industrial effluent. In this work, obtained data confirm the high potential of trace elements measurements in these biogenic carbonates as proxies of different environmental conditions.

Addressing the use of PDIF-CN2 molecules in the development of n-type organic field-effect transistors for biosensing applications.

BACKGROUND: There is no doubt that future discoveries in the field of biochemistry will depend on the implementation of novel biosensing techniques, able to record biophysiological events with minimal biological interference. In this respect, organic electronics may represent an important new tool for the analysis of structures ranging from single molecules up to cellular events. Specifically, organic field-effect transistors (OFET) are potentially powerful devices for the real-time detection/transduction of bio-signals. Despite this interest, up to date, the experimental data useful to support the development of OFET-based biosensors are still few and, in particular, n-type (electron-transporting) devices, being fundamental to develop highly-performing circuits, have been scarcely investigated. METHODS: Here, films of N,N'-1H,1H-perfluorobutyldicyanoperylene-carboxydi-imide (PDIF-CN2) molecules, a recently-introduced and very promising n-type semiconductor, have been evaporated on glass and silicon dioxide substrates to test the biocompatibility of this compound and its capability to stay electrically-active even in liquid environments. RESULTS: We found that PDIF-CN2 transistors can work steadily in water for several hours. Biocompatibility tests, based on in-vitro cell cultivation, remark the need to functionalize the PDIF-CN2 hydrophobic surface by extra-coating layers (i.e. poly-l-lysine) to favor the growth of confluent cellular populations. CONCLUSIONS: Our experimental data demonstrate that PDIF-CN2 compound is an interesting organic semiconductor to develop electronic devices to be used in the biological field. GENERAL SIGNIFICANCE: This work contributes to define a possible strategy for the fabrication of low-cost and flexible biosensors, based on complex organic complementary metal-oxide-semiconductor (CMOS) circuitry including both p- (hole-transporting) and n-type transistors. This article is part of a Special Issue entitled Organic Bioelectronics-Novel Applications in Biomedicine.

Towards the realization of label-free biosensors through impedance spectroscopy integrated with IDES technology.

Impedance spectroscopy (IS) is a powerful technique for analysis of the complex electrical impedance of a large variety of biological systems, because it is sensitive both to surface phenomena and to changes of bulk properties. A simple and convenient method of analysis of cell properties by IS is described. An interdigitated electrodes configuration was used for the measurements; human epithelial cells were grown on the device to investigate the complex dielectric response as a function of frequency, in order to test the suitability of the device for use as a label-free biosensor. To test the ability of the device to detect channels in the cell membrane, the effect of drugs known to affect membrane integrity was also investigated. The frequency response of the admittance (i.e. the reciprocal of the impedance) can be well fitted by a model based on very simple assumptions about the cells coating the device surface and the current flow; from the calculations, membrane-specific capacitance and information about cell adhesion can be inferred. These preliminary efforts have shown that our configuration could lead to a label-free non-invasive technique for biosensing and cellular behavior monitoring which might prove useful in investigation of the basic properties of cells and the effect of drugs by estimation of some fundamental properties and modification of the electrical characteristics of the device.

[Translated article] Analysis of the results and adverse factors of arthroscopic repair of degenerative subscapular lesions.

OBJECTIVE: To carry out a review of degenerative subscapularis ruptures (SSC) after their arthroscopic repair and to evaluate whether the results are comparable in terms of pain and function to those of younger patients with traumatic ruptures. METHODS: The data of 80 SSC tears of the 660 rotator cuff tears operated on by the same team of surgeons from June 2008 to June 2018 were retrospectively reviewed. The clinical data of the surgical indications were collected: age, gender, laterality, intervention delay, associated pathologies, location of pain, value of the Visual Analogue Scale (VAS) and the Constant-Murley test (CMT); surgical data were also collected: type and size of lesion, associated biceps injury and associated surgical procedure, coracoid stenosis and associated surgical procedure, number and type of anchors used. A statistical study was performed with multiple linear regression test, parametric tests (Student's t or ANOVA) and non-parametric tests. RESULTS: Of 80 patients, 36 were women (45%) and 44, men (55%); mean age 61 years (range 47-81); mean delay of surgery 3.5 months (range 1-6); right shoulder affected in 46 cases (57.5%), left in 34 (42.5%); 22 (27.5%) were isolated lesions, 58 (72.5%) were associated with supraspinatus rupture (SE). The mean improvement was 5.0 points in terms of the VAS and 39.9 points on average in the CMT. New breakage rate, 1.25%. Adverse factors: size of the tear, delay in intervention, women. Patients with type I-B rupture have a better overall result in the CMT than types I-A and III. The longer the delay, the worse results are observed, both for the VAS and the CMT. Women present worse and statistically significant results both in the VAS (p 0.00) and in the CMT (p 0.01). CONCLUSIONS: Excellent and good results have been obtained in this group of patients, but there are adverse factors such as the size of the tear, the duration of the symptoms and the association of other pathologies, especially in women.

Analysis of the results and adverse factors of arthroscopic repair of degenerative subscapular lesions. / Análisis de los resultados y los factores adversos de la reparación artroscópica de las lesiones del subescapular de origen degenerativo.

OBJECTIVE: To carry out a review of degenerative subscapularis ruptures (SSC) after their arthroscopic repair and to evaluate whether the results are comparable in terms of pain and function to those of younger patients with traumatic ruptures. METHODS: The data of 80 SSC tears of the 660 rotator cuff tears operated on by the same team of surgeons from June 2008 to June 2018 were retrospectively reviewed. The clinical data of the surgical indications were collected: age, gender, laterality, intervention delay, associated pathologies, location of pain, value of the Visual Analogue Scale (VAS) and the Constant-Murley test (CMT); surgical data were also collected: type and size of lesion, associated biceps injury and associated surgical procedure, coracoid stenosis and associated surgical procedure, number and type of anchors used. A statistical study was performed with multiple linear regression test, parametric tests (Student's t or ANOVA) and non-parametric tests. RESULTS: Of 80 patients, 36 were women (45%) and 44, men (55%); mean age 61years (range 47 to 81); mean delay of surgery 3.5months (range 1 to 6); right shoulder affected in 46 cases (57.5%), left in 34 (42.5%); 22 (27.5%) were isolated lesions, 58 (72.5%) were associated with supraspinatus rupture (SE). The mean improvement was 5.0 points in terms of the VAS and 39.9 points on average in the CMT. New breakage rate, 1.25%. Adverse factors: size of the tear, delay in intervention, women. Patients with type I-B rupture have a better overall result in the CMT than types I-A and III. The longer the delay, the worse results are observed, both for the VAS and the CMT. Women present worse and statistically significant results both in the VAS (P=.00) and in the CMT (P=.01). CONCLUSIONS: Excellent and good results have been obtained in this group of patients, but there are adverse factors such as the size of the tear, the duration of the symptoms and the association of other pathologies, especially in women.

The immediate effects of diacutaneous fibrolysis on pain and mobility in patients suffering from painful shoulder: a randomized placebo-controlled pilot study.

OBJECTIVES: To describe the immediate effects of diacutaneous fibrolysis on pain and mobility in patients suffering from painful shoulder, and to assess the ability of the placebo technique to blind participants to group allocation. DESIGN: A double-blind before-after randomized placebo-controlled pilot study. SETTING: Two public centres of Primary Health Care of the Spanish National Health System. PARTICIPANTS: Fifty patients (29 women, 21 men) with a diagnosis of painful shoulder of subacromial origin were included. INTERVENTION: Participants were randomly allocated to one of two groups. The intervention group (N = 25) was actually treated with diacutaneous fibrolysis, while the placebo group (N = 25) was treated with placebo diacutaneous fibrolysis. MEASUREMENTS: Active range of motion (flexion, abduction, extension, external and internal rotation) and pain intensity in the hand-behind-back position were measured. Participants were also asked about their perception in terms of comfort of the technique and results obtained. RESULTS: Between-groups differences were significant in flexion (mean 11.4 degrees; 95% confidence interval (CI) 5.7-17.1), abduction (mean 7.2 degrees; 95% CI 2.0-12.5) and internal rotation movements (mean 3.1 cm; 95% CI 0.1-6.1). There were no significant differences between groups in pain intensity, extension or external rotation movements. The placebo technique showed its ability to blind participants to group allocation. None of the participants suffered any adverse effects from diacutaneous fibrolysis. CONCLUSION: Diacutaneous fibrolysis may be an effective and safe therapeutic option to improve active range of motion in patients suffering from painful shoulder.

Stable isotopes and C/N ratios in marine sediments as a tool for discriminating anthropogenic impact.

Sources of anthropogenic pollution were categorised by combining elemental and isotopic techniques (C/N ratios and δ(13)C, δ(15)N) on samples of surficial sediments in the harbour of Naples (Southern Tyrrhenian Sea, Italy). The study area, due to the intense and diversified industrial and commercial activities, is an appropriate natural laboratory to verify reliability and relevance of geochemical methodologies applied to exploration of sources, pathways and fate of contaminants in highly polluted coastal marine systems. Application of cluster analysis to the whole dataset and resolution of a δ(13)C and δ(15)N Moore-Penrose system equation provided information to reliably discriminate and identify anthropogenic point sources in the studied sediments. In particular, effects of oil spilling and wastewater discharge within the area of the harbour of Naples were clearly discriminated thus suggesting high-potential of the two numerical techniques, applied to the C and N elemental and isotopic values, to explore effects of anthropogenic impact in marginal and confined coastal basins. The δ(15)N values showed high sensitivity to discriminate sewage discharges (treated or untreated organic matter), clearly indicating the point of emissions. The δ(13)C shows indirect capability of discriminating crude oil and petroleum products.

Persistent warm Mediterranean surface waters during the Roman period.

Reconstruction of last millennia Sea Surface Temperature (SST) evolution is challenging due to the difficulty retrieving good resolution marine records and to the several uncertainties in the available proxy tools. In this regard, the Roman Period (1 CE to 500 CE) was particularly relevant in the socio-cultural development of the Mediterranean region while its climatic characteristics remain uncertain. Here we present a new SST reconstruction from the Sicily Channel based in Mg/Ca ratios measured on the planktonic foraminifer Globigerinoides ruber. This new record is framed in the context of other previously published Mediterranean SST records from the Alboran Sea, Minorca Basin and Aegean Sea and also compared to a north Hemisphere temperature reconstruction. The most solid image that emerges of this trans-Mediterranean comparison is the persistent regional occurrence of a distinct warm phase during the Roman Period. This record comparison consistently shows the Roman as the warmest period of the last 2 kyr, about 2 °C warmer than average values for the late centuries for the Sicily and Western Mediterranean regions. After the Roman Period a general cooling trend developed in the region with several minor oscillations. We hypothesis the potential link between this Roman Climatic Optimum and the expansion and subsequent decline of the Roman Empire.

Fecal pollution source tracking and thalassogenic diseases: The temporal-spatial concordance between maximum concentrations of human mitochondrial DNA in seawater and Hepatitis A outbreaks among a coastal population.

Fecal pollution source tracking (FST) studies the origin of fecal contamination and promotes action to eliminate it to improve human health and environmental sustainability. This work presents the temporal and spatial relations of human mitochondrial DNA (HmtDNA), fecal coliforms (FC) and live microbial biomass (ATP) in seawater during a hepatitis A outbreak among a human coastal population. The study area is approximately 100 km along the coastline of the Biobío Region in the southeastern Pacific (Humboldt Current System, Chile). Total data from the swash zone from summer 2015 to autumn 2016 show there were significant positive log-log correlations between FC and HmtDNA (R = 0.32) and ATP (R = 0.31). These correlations were highest during the austral spring of 2015 (R = 0.53 and 0.58 respectively), when HmtDNA also correlated significantly with ATP (R = 0.86). Maximum average values of the parameters measured in this season showed a temporal-spatial concordance with the peak in the number of hepatitis A cases among the nearby coastal population. FC correlated significantly with HmtDNA (R = 0.98) in the water column of the coastal zone close to Concepción Bay during the austral summer of 2016 and in the swash zone of the bay (R = 0.68) throughout the study period. Hepatitis A virus (HAV) has also been detected in organisms and seawater in Concepción Bay, which is consistent with the high incidence of hepatitis A among the coastal population. The concordance between human fecal pollution in the study area and a seasonal hepatitis A outbreak strongly suggests that HmtDNA and its relation with FC and ATP in the coastal zone of marine environments can be used as a proxy to evaluate the risk of outbreaks of thalassogenic diseases.